Baseline and Outcome Characteristics of Multiple Valve Surgery Compared with Single Valve Procedures in Mainland China: A Multicenter Experience
DOI:
https://doi.org/10.1532/hsf.2369Abstract
Background: To compare baseline and outcome characteristics of multiple valve surgery with single-valve procedures in a multicenter patient population of mainland China.
Methods: From January 2008 to December 2012, data from 14,322 consecutive patients older than 16 years who underwent heart valve surgery at five cardiac surgical centers (except pulmonary valve operations) were collected. The patients were divided into seven subgroups according to the type of valve procedures, and baseline characteristics and postoperative outcomes were contrasted between all seven combinations of single-valve and multiple-valve procedures involving aortic, mitral, and tricuspid valves. Two independent logistic regression analyses were performed and multivariable risk factors for mortality were compared, with emphasis on single-valve versus multiple-valve surgery.
Results: Baseline characteristics for MUV procedures
(n = 8945) shared many differences to those for single-valve procedures (n = 5377). Proportion of females, chronic obstructive pulmonary disease, cerebrovascular disease, renal impairment, congestive heart failure, NHYA class III-IV, atrial fibrillation, pulmonary hypertension, and decreased ejection fraction were more common in MUV subgroups, and smoker, hypertension, dyslipidemia, active infectious endocarditis, and coronary bypass graft was less frequent. In-hospital mortality was higher for MUV as compared with single-valve procedures (2.4% versus 1.6%, P = .007). Preoperative independent predictors for mortality of patients undergoing MUV procedures were age, chronic obstructive pulmonary disease, diabetes mellitus, renal dysfunction, dialysis, congestive heart failure, cardiogenic shock, NYHA class III-IV, mitral stenosis, tricuspid regurgitation, mitral valve replacement, and concomitant CABG. However, risk factors for mortality were relatively different between single-valve and MUV procedures.
Conclusion: Baseline characteristics and epidemiology were different between MUV and single-valve procedures. The in-hospital mortality and postoperative complications for MUV procedures remained considerably higher and determinants of mortality were relatively different across procedures types. These findings serve as a benchmark for further studies, as well as suggest a continued search for explanations of MUV outcomes.
References
Alsoufi B, Rao V, Borger MA, et al. 2006. Short- and long-term results of triple valve surgery in the modern era. Ann Thorac Surg 81:2172-8.
Bhudia SK, McCarthy PM, Kumpati GS, et al. 2007. Improved outcomes after aortic valve surgery for chronic aortic regurgitation with severe left ventricular dysfunction. J Am Coll Cardiol 49:1465-71.
Brown JM, O’Brien SM, Wu C, et al. 2009. 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. J Thorac Cardiovasc Surg 137:82-90.
Chatterjee S, Rankin JS, Gammie JS, et al. 2013. Isolated mitral valve surgery risk in 77,836 patients from the Society of Thoracic Surgeons Database. Ann Thorac Surg 96:1587-95.
De Oliveira NC, David TE, Armstrong S, et al. 2005. Aortic and mitral valve replacement with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes. J Thorac Cardiovasc Surg 129:286-90.
Dreyfus GD, Corbi PJ, Chan KM, et al. 2005. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg 79:127-32.
El-Essawi A, Hajek T, Skorpil J, et al. 2010. A prospective randomised multicentre clinical comparison of a minimised perfusion circuit versus conventional cardiopulmonary bypass. Eur J Cardiothorac Surg 38:91-7.
Feindel CM, Tufail Z, David TE, et al. 2003. Mitral valve surgery in patients with extensive calcification of the mitral annulus. J Thorac Cardiovasc Surg 126:777-82.
Gammie JS, Sheng S, Griffith BP, et al. 2009. Trends in mitral valve surgery in the United States: results from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 87:1431-7.
Gillinov AM, Blackstone EH, Cosgrove DM, et al. 2003. Mitral valve repair with aortic valve replacement is superior to double valve replacement. J Thorac Cardiovasc Surg 125:1372-87.
Hannan EL, Racz M, Culliford AT, et al. 2013. Risk score for predicting in-hospital/30-day mortality for patients undergoing valve and valve/coronary artery bypass graft surgery. Ann Thorac Surg 95:1282-90.
Hosmer DW, Lemeshow, S. 2000. Applied Logistic Regression. New Jersey: John Wiley & Sons. 2000.
Jaussaud N, Gariboldi V, Giorgi R, et al. 2009. Risk of reoperation for aortic bioprosthesis dysfunction. J Heart Valve Dis 18:256-61.
Lee R, Li S, Rankin JS, et al, for the Society of Thoracic Surgeons Adult Cardiac Surgical Database. 2011. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg 91:677-84.
Little RJA, Rubin DB. 2002. Statistical analysis with missing data. 2nd ed. Hoboken, NJ: Wiley-Interscience.
Nkomo VT, Gardin JM, Skelton TN, et al. 2006. Burden of valvular heart diseases: A population-based study. Lancet 368:1005-11.
Nowicki ER, Weintraub RW, Birkmeyer NJO, et al. 2003. Mitral valve repair and replacement in northern New England. Am Heart J 145:1058-62.
Nowicki ER, Birkmeyer NJ, Weintraub RW, et al. 2004. Multivariable prediction of in-hospital mortality associated with aortic and mitral valve surgery in northern New England. Ann Thorac Surg 77:1966-77.
O’Brien SM, Shahian DM, Filardo G, et al. 2009. The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 2-Isolated Valve Surgery. Ann Thorac Surg 88:S23-42.
Rankin JS, Hammill BG, Ferguson TB, et al. 2006. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg 131:547-57.
Rankin JS, He X, O’Brien SM, et al. 2013. The Society of Thoracic Surgeons Risk Model for Operative Mortality After Multiple Valve Surgery. Ann Thorac Surg 95:1484-90.
Rankina JS, Thouranib VH, Suric RM, et al. 2013. Associations between valve repair and reduced operative mortality in 21,056 mitral/tricuspid double valve procedures. Eur J Cardiothorac Surg 44:472-7.
Savage EB, Ferguson TB, DiSesa VJ. 2003. Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database. Ann Thorac Surg 75:820-5.
Shahian DM, O’Brien SM, Filardo G, et al. 2009. The Society of Thoracic Surgeons 2008 Cardiac Surgery Risk Models: Part 3-Valve Plus Coronary Artery Bypass Grafting Surgery. Ann Thorac Surg 88:S43-62.
Shiran A, Sagie A. 2009. Tricuspid regurgitation in mitral valve disease. J Am Coll Cardiol 53:401-8.
Suri RM, Schaff HV, Dearani JA, et al. 2006. Recurrent mitral regurgitation after repair: should the mitral valve be rerepaired? J Thorac Cardiovasc Surg 132:1390-7.
Talwar S, Mathur A, Choudhary SK, et al. 2007. Aortic valve replacement with mitral valve repair compared with combined aortic and mitral valve replacement. Ann Thorac Surg 84:1219-25.
Taylor NE, O’Brien S, Edwards FH, et al. 2005. Relationship between race and mortality and morbidity after valve replacement surgery. Circulation 111:1305-12.
Vassileva CM, Shabosky J, Boley T, et al. 2012. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg 143:1043-9.
Vassileva CM, Li S, Thourani VH, et al. 2014. Outcome characteristics of multiple valve surgery: comparison to single valves. Innovations 9:27-32.
Zegdi R, Sleilaty G, Latrémouille C, et al. 2008. Reoperation for failure of mitral valve repair in degenerative disease: a single-center experience. Ann Thorac Surg 86:1480-4.
