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J Am Coll Cardiol, 2001; 37:885-892
© 2001 by the American College of Cardiology Foundation
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CLINICAL STUDY: VALVE DISEASE

Prediction of operative mortality after valve replacement surgery

Fred H. Edwards, MD, FACC*, Eric D. Peterson, MD, MPH, FACC{dagger}, Laura P. Coombs, PhD{dagger}, Elizabeth R. DeLong, PhD{dagger}, W. R. Eric Jamieson, MD, FACC{ddagger}, A. Laurie W. Shroyer, PhD§ and Frederick L. Grover, MD, FACC§

* Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville, Florida, USA
{dagger} Duke Clinical Research Institute, Durham, North Carolina, USA
{ddagger} University of British Columbia, Vancouver, Canada
§ University of Colorado Health Science Center, Denver, Colorado, USA

Manuscript received July 28, 2000; revised manuscript received October 16, 2000, accepted November 29, 2000.

Reprint requests and correspondence: Dr. Fred H. Edwards, Division of Cardiothoracic Surgery, University of Florida Health Science Center, 653-2 West Eighth Street, Jacksonville, Florida 32209-6511
fhe{at}mediaone.net

OBJECTIVES

We sought to develop national benchmarks for valve replacement surgery by developing statistical risk models of operative mortality.

BACKGROUND

National risk models for coronary artery bypass graft surgery (CABG) have gained widespread acceptance, but there are no similar models for valve replacement surgery.

METHODS

The Society of Thoracic Surgeons National Cardiac Surgery Database was used to identify risk factors associated with valve surgery from 1994 through 1997. The population was drawn from 49,073 patients undergoing isolated aortic valve replacement (AVR) or mitral valve replacement (MVR) and from 43,463 patients undergoing CABG combined with AVR or MVR. Two multivariable risk models were developed: one for isolated AVR or MVR and one for CABG plus AVR or CABG plus MVR.

RESULTS

Operative mortality rates for AVR, MVR, combined CABG/AVR and combined CABG/MVR were 4.00%, 6.04%, 6.80% and 13.29%, respectively. The strongest independent risk factors were emergency/salvage procedures, recent infarction, reoperations and renal failure. The c-indexes were 0.77 and 0.74 for the isolated valve replacement and combined CABG/valve replacement models, respectively. These models retained their predictive accuracy when applied to a prospective patient population undergoing operation from 1998 to 1999. The Hosmer-Lemeshow goodness-of-fit statistic was 10.6 (p = 0.225) for the isolated valve replacement model and 12.2 (p = 0.141) for the CABG/valve replacement model.

CONCLUSIONS

Statistical models have been developed to accurately predict operative mortality after valve replacement surgery. These models can be used to enhance quality by providing a national benchmark for valve replacement surgery.

Abbreviations and Acronyms
  AVR = aortic valve replacement
  BSA = body surface area
  CABG = coronary artery bypass grafting
  MI = myocardial infarction
  MVR = mitral valve replacement
  OM = operative mortality
  STS = Society of Thoracic Surgeons
  STS Database = Society of Thoracic Surgeons National Cardiac Surgery Database
  US = United States




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