Isolated aortic valve replacement in North America comprising 108,687 patients in 10 years: Changes in risks, valve types, and outcomes in the Society of Thoracic Surgeons National Database
Open accessAbstract
Objective More than 200,000 aortic valve replacements are performed annually worldwide. We describe changes in the aortic valve replacement population during 10 years in a large registry and analyze outcomes.Methods The Society of Thoracic Surgeons National Database was queried for all isolated aortic valve replacements between January 1, 1997, and December 31, 2006. After exclusion for endocarditis and missing age or sex data, 108,687 isolated aortic valve replacements were analyzed. Time-related trends were assessed by comparing distributions of risk factors, valve types, and outcomes in 1997 versus 2006. Differences in case mix were summarized by comparing average predicted mortality risks with a logistic regression model. Differences across subgroups and time were assessed.Results There was a dramatic shift toward use of bioprosthetic valves. Aortic valve replacement recipients in 2006 were older (mean age 65.9 vs 67.9 years, P < .001) with higher predicted operative mortality risk (2.75 vs 3.25, P < .001); however, observed mortality and permanent stroke rate fell (by 24% and 27%, respectively). Female sex, age older than 70 years, and ejection fraction less than 30% were all related to higher mortality, higher stroke rate and longer postoperative stay. There was a 39% reduction in mortality with preoperative renal failure.Conclusions Morbidity and mortality of isolated aortic valve replacement have fallen, despite gradual increases in patient age and overall risk profile. There has been a shift toward bioprostheses. Women, patients older than 70 years, and patients with ejection fraction less than 30% have worse outcomes for mortality, stroke, and postoperative stay.
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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 [209]
The Results and Discussion report that mortality after isolated AVR fell despite increasing age, comorbidities, and predicted risk. But this study covers 1997–2006, a 10-year period, not the two decades claimed. (LLM, conf=0.88)
Experimental — accuracy not yet measuredFor isolated aortic valve replacement, the overall 30-day mortality rate is currently under 3% according to the STS database and the German Aortic Valve Registry.
“For an isolated AVR, the overall 30-day mortality rate is currently under 3% as reported in the Society of Thoracic Surgeons (STS) database and German Aortic Valve Registry (GARY)209;210.”
From Calcific aortic stenosis (2016) · cites this paper as [209]
Table 4 reports 2.6% observed mortality for isolated AVR in the STS database in 2006, supporting the under-3% figure. But the End Points section specifies that this study measured in-hospital mortality and did not analyze postdischarge 30-day mortality, so it does not establish the claimed 30-day rate. The German registry is associated with a separate citation and is not assessed here. (LLM, conf=0.90)
Experimental — accuracy not yet measuredThere has been a shift away from mechanical valves toward greater use of bioprosthetic valves, particularly in patients over 65 years of age.
“There has been a shift away from mechanical valves toward greater use of bioprosthetic valves, particularly in patients >65 years of age (Figure 12)209.”
From Calcific aortic stenosis (2016) · cites this paper as [209]
The Results (page not provided) report that bioprosthetic valve use rose to 78.4% while mechanical valve use fell to 20.5%, supporting the overall shift. The Discussion links valve choice to an aging patient population, but our copy does not establish that the shift was particularly pronounced among patients over 65. (LLM, conf=0.85)
Experimental — accuracy not yet measuredSurgical aortic valve replacement has excellent results with low mortality in low-risk populations.
“Surgical AVR has excellent results with low mortality in low risk populations209.”
From Calcific aortic stenosis (2016) · cites this paper as [209]
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- Authors
- Brown, J. M., O'Brien, S. M., Wu, C., Sikora, J. A. H., Griffith, B. P., & Gammie, J. S.
- Affiliations
- University of Maryland Medical Center (US)
- Corresponding author
- Brown, James M.
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2009-01
- Volume
- 137
- Issue
- 1
- Pages
- 82-90
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2081807377
- Cited by
- 937
- References
- 20
- Citations by year
- 2026: 13 · 2025: 25 · 2024: 29 · 2023: 43 · 2022: 41 · 2021: 49 · 2020: 71 · 2019: 71 · 2018: 73 · 2017: 58 · 2016: 73 · 2015: 97 · 2014: 67 · 2013: 80 · 2012: 50
- FWCI
- 31.61
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Aortic Disease and Treatment Approaches
- Health Sciences › Medicine › Surgery › Cardiac and Coronary Surgery Techniques
- Keywords
- isolated aortic valve replacement, bioprosthetic heart valves, mechanical valves, postoperative mortality, postoperative stroke, length of hospital stay, risk factors, ejection fraction, preoperative renal failure, temporal trends, case mix
- MeSH terms
- Aged, Aged, 80 and over, Aortic Valve, Bioprosthesis, Female, Heart Valve Prosthesis, Humans, Male, Middle Aged, Postoperative Complications, Prosthesis Design, Registries, Risk Factors, Time Factors, United States, Databases, Factual, Treatment Outcome
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