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Cited by 176Cardiac Valve Diseases and TreatmentsCardiac and Coronary Surgery TechniquesAortic Disease and Treatment Approaches

Fifteen-Year Outcome Trends for Valve Surgery in North America

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Lee, Richard, Li, Shuang, Rankin, J. Scott, O'Brien, Sean M., Gammie, James S., Peterson, Eric D., McCarthy, Patrick M., Edwards, Fred H.·2011·The Annals of Thoracic Surgery
DOI 10.1016/j.athoracsur.2010.11.009
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Abstract

Background Although results in valvular heart surgery may be improving, too few cases are available in most centers to quantify changes, especially for uncommon procedural categories. This study examined comprehensively national trends in valve surgery outcomes over the past 15 years.Methods From 1993 through 2007, 623,039 valve procedures were grouped into single aortic (A), mitral (M), and tricuspid (T) operations, along with AM, MT, AT, and AMT multiple valves ± coronary artery bypass graft surgery. Pulmonary valve surgery was excluded. Trends in baseline characteristics were documented, and logistic regression adjusted for differences in patient profiles. Outcomes were expressed as unadjusted operative mortality, adjusted odds ratios for mortality, and a composite of mortality and major complications.Results Single valves comprised 89% of valve surgery and multiple valves, 11%. Preoperative patient risk profiles worsened over time. Mortality rates were higher for multiple valves, but all mortality rates fell significantly over the 15 years (p <0.001). The composite of mortality and major morbidity did not improve, however, largely because of increasing pulmonary/infectious complications. Overall, cardiac etiology accounted for 54% of deaths, and pulmonary/infectious etiologies for 16%. Cardiac etiology of death fell by 16% over time, but pulmonary death and complications increased by 78% and 39%, respectively.Conclusions Preoperative patient profiles for cardiac valve procedures have worsened over time. Risk-adjusted mortalities have fallen for all valve surgery, but remain higher for multiple valves. The finding of increasing pulmonary deaths and complications suggests that prevention and improved management of pulmonary and infectious complications could be an important focus for quality improvement.

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  • Mortality associated with aortic valve replacement has decreased dramatically over the past two decades despite increasing age and comorbidities.

    “Despite increasing age and comorbidities, the mortality associated with AVR has decreased dramatically during the past two decades208;209.”

    From Calcific aortic stenosis (2016) · cites this paper as [208]

    The Trends in Mortality section and Table 2 report that mortality for isolated aortic valve surgery fell from 5.6% to 4.4%, while Trends in Patient Demographics reports increasing age and several worsening risk factors. The study covers 1993–2007, however, so it supports a decline over 15 years, not the claimed two decades. (LLM, conf=0.86)

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Research works printed but not linked: 1

  1. [31]31. Lavie CJ, Milani RV, Ventura HO. Obesity and cardiovascu- lar disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol 2009;53:1925-32.

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Authors
Lee, R., Li, S., Rankin, J. S., O'Brien, S. M., Gammie, J. S., Peterson, E. D., McCarthy, P. M., & Edwards, F. H.
Affiliations
  • Northwestern University (US)
  • Duke University (US)
  • Vanderbilt University (US)
  • University of Maryland, Baltimore (US)
  • UF Health Shands Hospital (US)
Corresponding author
Rankin, J. Scott
ORCID
Venue
The Annals of Thoracic Surgery
Publisher
Elsevier BV
Published
2011-03
Volume
91
Issue
3
Pages
677-684
ISSN
0003-4975 (ISSN-L)
DOI
10.1016/j.athoracsur.2010.11.009
OpenAlex
W2043180642
Cited by
176
References
35
Citations by year
2026: 5 · 2025: 5 · 2024: 12 · 2023: 12 · 2022: 6 · 2021: 18 · 2020: 9 · 2019: 17 · 2018: 10 · 2017: 13 · 2016: 11 · 2015: 15 · 2014: 13 · 2013: 16 · 2012: 10
FWCI
9.14
Type
journal article
Language
en
Open access
Licence
Locations
  • The Annals of Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
Keywords
heart valve surgery, surgical outcomes trends, postoperative mortality, multiple valve replacement, aortic valve surgery, mitral valve surgery, tricuspid valve surgery, pulmonary complications, infectious complications, coronary artery bypass grafting, quality improvement
MeSH terms
Aged, Aged, 80 and over, Follow-Up Studies, Cardiac Surgical Procedures, Heart Valve Diseases, Humans, Middle Aged, North America, Retrospective Studies, Risk Factors, Time Factors, Survival Rate

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