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SCIENTIFIC STATEMENT:
Prevention of Torsade de Pointes in Hospital Settings
ACC 2009 Advocacy Position Statement: Principles for Comparative Effectiveness Research
2009 ACCF/AHA Focused Update on Perioperative Beta Blockade Incorporated Into the ACC/AHA 2007 Guidelines on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery
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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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The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI) Endorsed by the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA)
J. Am. Coll. Cardiol., May 3, 2005; 45(9): 1554 - 1560.
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 J. Thorac. Cardiovasc. Surg.Home page
American College of Cardiology Foundation (ACCF) a, T. A. Vassiliades Jr, P. C. Block, L. H. Cohn, D. H. Adams, J. S. Borer, T. Feldman, D. R. Holmes, W. K. Laskey, B. W. Lytle, et al.
The clinical development of percutaneous heart valve technology: A position statement of the Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI)
J. Thorac. Cardiovasc. Surg., May 1, 2005; 129(5): 970 - 976.
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 Ann. Thorac. Surg.Home page
T. A. Vassiliades Jr, P. C. Block, L. H. Cohn, D. H. Adams, J. S. Borer, T. Feldman, D. R. Holmes, W. K. Laskey, B. W. Lytle, M. J. Mack, et al.
The Clinical Development of Percutaneous Heart Valve Technology: A Position Statement of The Society of Thoracic Surgeons (STS), the American Association for Thoracic Surgery (AATS), and the Society for Cardiovascular Angiography and Interventions (SCAI)
Ann. Thorac. Surg., May 1, 2005; 79(5): 1812 - 1818.
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 Ann. Thorac. Surg.Home page
P. M. Ho, F. A. Masoudi, J. A. Spertus, P. N. Peterson, A. L. Shroyer, M. McCarthy Jr, F. L. Grover, K. E. Hammermeister, and J. S. Rumsfeld
Depression Predicts Mortality Following Cardiac Valve Surgery
Ann. Thorac. Surg., April 1, 2005; 79(4): 1255 - 1259.
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 CirculationHome page
N. E. Taylor, S. O'Brien, F. H. Edwards, E. D. Peterson, and C. R. Bridges
Relationship Between Race and Mortality and Morbidity After Valve Replacement Surgery
Circulation, March 15, 2005; 111(10): 1305 - 1312.
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 Eur. J. Cardiothorac. Surg.Home page
R. G. Fuster, J. A. M. Argudo, O. G. Albarova, F. H. Sos, S. C. Lopez, M. B. Codoner, J. A. B. Minano, and I. R. Albarran
Patient-prosthesis mismatch in aortic valve replacement: really tolerable?
Eur. J. Cardiothorac. Surg., March 1, 2005; 27(3): 441 - 449.
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 J Am Coll CardiolHome page
J. G. Byrne, M. Leacche, D. Unic, J. D. Rawn, D. I. Simon, C. D. Rogers, and L. H. Cohn
Staged initial percutaneous coronary intervention followed by valve surgery ("hybrid approach") for patients with complex coronary and valve disease
J. Am. Coll. Cardiol., January 4, 2005; 45(1): 14 - 18.
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 Eur Heart JHome page
P. Lim, J. L. Monin, M. Monchi, J. Garot, A. Pasquet, L. Hittinger, J. L. Vanoverschelde, A. Carayon, and P. Gueret
Predictors of outcome in patients with severe aortic stenosis and normal left ventricular function: role of B-type natriuretic peptide
Eur. Heart J., November 2, 2004; 25(22): 2048 - 2053.
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 Ann. Thorac. Surg.Home page
D. M. Shahian, E. H. Blackstone, F. H. Edwards, F. L. Grover, G. L. Grunkemeier, D. C. Naftel, S. A.M. Nashef, W. C. Nugent, and E. D. Peterson
Cardiac Surgery Risk Models: A Position Article
Ann. Thorac. Surg., November 1, 2004; 78(5): 1868 - 1877.
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 NEJMHome page
M. Enriquez-Sarano and A. J. Tajik
Aortic Regurgitation
N. Engl. J. Med., October 7, 2004; 351(15): 1539 - 1546.
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 CirculationHome page
F. Langer, D. Aicher, A. Kissinger, O. Wendler, H. Lausberg, R. Fries, and H.-J. Schafers
Aortic Valve Repair Using a Differentiated Surgical Strategy
Circulation, September 14, 2004; 110(11_suppl_1): II-67 - II-73.
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 CirculationHome page
J. S. Collins, A. Evangelista, C. A. Nienaber, E. Bossone, J. Fang, J. V. Cooper, D. E. Smith, P. T. O'Gara, T. Myrmel, D. Gilon, et al.
Differences in Clinical Presentation, Management, and Outcomes of Acute Type A Aortic Dissection in Patients With and Without Previous Cardiac Surgery
Circulation, September 14, 2004; 110(11_suppl_1): II-237 - II-242.
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 Ann. Thorac. Surg.Home page
C. K. Haan, C. I. Cabral, D. A. Conetta, L. P. Coombs, and F. H. Edwards
Selecting patients with mitral regurgitation and left ventricular dysfunction for isolated mitral valve surgery
Ann. Thorac. Surg., September 1, 2004; 78(3): 820 - 825.
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 J Am Coll CardiolHome page
S. H. Rahimtoola
The year in valvular heart disease
J. Am. Coll. Cardiol., February 4, 2004; 43(3): 491 - 504.
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 Ann. Thorac. Surg.Home page
W. F. Northrup III, R. W. Emery, D. M. Nicoloff, T. J. Lillehei, A. R. Holter, and D. P. Blake
Opposite trends in coronary artery and valve surgery in a large multisurgeon practice, 1979-1999
Ann. Thorac. Surg., February 1, 2004; 77(2): 488 - 495.
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 Ann. Thorac. Surg.Home page
S. C. Gardner, G. K. Grunwald, J. S. Rumsfeld, J. C. Cleveland Jr, L. M. Schooley, D. Gao, F. L. Grover, G. O. McDonald, and A. L. Shroyer
Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery
Ann. Thorac. Surg., February 1, 2004; 77(2): 549 - 556.
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 J. Thorac. Cardiovasc. Surg.Home page
Y. Berkun, A. Elami, K. Meir, D. Mevorach, and Y. Naparstek
Increased morbidity and mortality in patients with antiphospholipid syndrome undergoing valve replacement surgery
J. Thorac. Cardiovasc. Surg., February 1, 2004; 127(2): 414 - 420.
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 Eur. J. Cardiothorac. Surg.Home page
R. A. Hopkins
Aortic valve leaflet sparing and salvage surgery: evolution of techniques for aortic root reconstruction
Eur. J. Cardiothorac. Surg., December 1, 2003; 24(6): 886 - 897.
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 J Am Coll CardiolHome page
J. S. Rumsfeld
Valve surgery in the elderly: A question of quality (of life)?
J. Am. Coll. Cardiol., October 1, 2003; 42(7): 1215 - 1217.
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 Ann. Thorac. Surg.Home page
W. A. Cooper, W. Brinkman, R. J. Petersen, and R. A. Guyton
Impact of renal disease in cardiovascular surgery: emphasis on the African-American patient
Ann. Thorac. Surg., October 1, 2003; 76(4): S1370 - 1376.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
C. Blais, J. G. Dumesnil, R. Baillot, S. Simard, D. Doyle, and P. Pibarot
Impact of Valve Prosthesis-Patient Mismatch on Short-Term Mortality After Aortic Valve Replacement
Circulation, August 26, 2003; 108(8): 983 - 988.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
I. Florath, U. P. Rosendahl, A. Mortasawi, S. F. Bauer, F. Dalladaku, I. C. Ennker, and J. C. Ennker
Current determinants of operative mortality in 1400 patients requiring aortic valve replacement
Ann. Thorac. Surg., July 1, 2003; 76(1): 75 - 83.
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 Eur Heart JHome page
B. Iung, G. Baron, E. G. Butchart, F. Delahaye, C. Gohlke-Barwolf, O. W. Levang, P. Tornos, J.-L. Vanoverschelde, F. Vermeer, E. Boersma, et al.
A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease
Eur. Heart J., July 1, 2003; 24(13): 1231 - 1243.
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 Ann. Thorac. Surg.Home page
R. Sharony, E. A. Grossi, P. C. Saunders, C. F. Schwartz, G. B. Ciuffo, F. G. Baumann, J. Delianides, R. M. Applebaum, G. H. Ribakove, A. T. Culliford,, et al.
Aortic valve replacement in patients with impaired ventricular function
Ann. Thorac. Surg., June 1, 2003; 75(6): 1808 - 1814.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
D. C. Miller
Ischemic mitral regurgitation redux--to repair or to replace?
J. Thorac. Cardiovasc. Surg., March 1, 2003; 125(90030): S58 - 61.
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 Card Surg AdultHome page
N. D. Desai and G. T. Christakis
Stented Mechanical/Bioprosthetic Aortic Valve Replacement
Card. Surg. Adult, January 1, 2003; 2(2003): 825 - 856.
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 Card Surg AdultHome page
T. Gudbjartsson, S. Aranki, and L. H. Cohn
Mechanical/Bioprosthetic Mitral Valve Replacement
Card. Surg. Adult, January 1, 2003; 2(2003): 951 - 986.
[Full Text]

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 Ann. Thorac. Surg.Home page
R. H. Mehta, K. A. Eagle, L. P. Coombs, E. D. Peterson, F. H. Edwards, F. D. Pagani, G. M. Deeb, S. F. Bolling, and R. L. Prager
Influence of age on outcomes in patients undergoing mitral valve replacement
Ann. Thorac. Surg., November 1, 2002; 74(5): 1459 - 1467.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
W. T. Brinkman, W. H. Williams, R. A. Guyton, E. L. Jones, and J. M. Craver
Valve replacement in patients on chronic renal dialysis: implications for valve prosthesis selection
Ann. Thorac. Surg., July 1, 2002; 74(1): 37 - 42.
[Abstract] [Full Text] [PDF]

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 Arch SurgHome page
F. L. Grover, J. C. Cleveland Jr, and L. W. Shroyer
Quality Improvement in Cardiac Care
Arch Surg, January 1, 2002; 137(1): 28 - 36.
[Abstract] [Full Text] [PDF]

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 J. Thorac. Cardiovasc. Surg.Home page
D. C. Miller
Ischemic mitral regurgitation redux--To repair or to replace?
J. Thorac. Cardiovasc. Surg., December 1, 2001; 122(6): 1059 - 1062.
[Full Text] [PDF]


 
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