The Effectiveness of Heart Valve Replacement Surgery in a Non-Referral Regional Hospital: The Analysis of Outcomes after Isolated and Complex Valve Replacement
DOI:
https://doi.org/10.1532/hsf.2373Abstract
Background: To comprehensively investigate early and late outcomes for all valve replacement surgery patients in a non-referral regional hospital database and to compare these results with the literature.
Methods: This was a retrospective study and made up of patients undergoing heart valve replacement in the cardiovascular department of a non-referral regional hospital between May 2008 and February 2018. Inclusion criteria were aortic, mitral and double valve replacement with or without CABG.
Results: 212 patients were included in the study. Of the 212 patients, 65 were aortic valve replacement, 119 were mitral valve replacement, 28 were double valve replacement patients. Mean follow-up of all patients was 3.4 ± 2.9 years. There was no significant difference among the groups regarding hospital mortality. The occurrence of acute renal failure and neurological event was the main factors of morbidity-associated mortality. Concomitant CABG procedure was found to be an independent predictor of early mortality after MVR. In the AVR group, there was no significant difference between AVR with CABG and without CABG regarding the 5-year survival rates; whereas in MVR and DVR group, there was a statistically significant difference between the groups. According to Cox proportional hazards model for determining factors related to late mortality, preoperative chronic renal failure and concomitant CABG were factors independently related to late mortality after MVR.
Conclusion: We believe that our study will contribute to the development of the outcomes of heart valve replacement surgery in these centers by supporting other non-heart center clinics in working toward acceptable morality rates for complex valve surgeries.
References
Biancari F, Martin M, Bordin G, et al. 2014. Basic data from 176 studies on the immediate outcome after aortic valve replacement with or without coronary artery bypass surgery. J Cardiothorac Vasc Anesth 28:1251-6.
Birkmeyer JD, Stukel TA, Siewers AE, et al. 2003. Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117-27.
Birkmeyer NJO, Marrin CAS, Morton JR, et al. 2000. Decreasing mortality for aortic and mitral valve surgery in Northern New England. Ann Thorac Surg 70:432-7.
Bolling SF, Dickstein ML, Levy JH, et al. 2000. Management strategies for high-risk cardiac surgery: improving outcomes in patients with heart failure. Heart Surg Forum 3:337-49.
Braunwald E. 2000. Aortic valve replacement: an update at the turn of the millennium. Eur Heart J 21:1032-3.
David TE, Armstrong S, Maganti M, et al. 2008. Clinical outcomes of combined aortic root replacement with mitral valve surgery. J Thorac Cardiovasc Surg 136:82-7.
de Waard GA, Jansen EK, de Mulder M, Vonk AB, Umans VS. 2012. Long-term outcomes of isolated aortic valve replacement and concomitant AVR and coronary artery bypass grafting. Neth Heart J 20:110-7.
Dewey TM, Herbert MA, Ryan WH, et al. Influence of surgeon volume on outcomes with aortic valve replacement. 2012. Ann Thorac Surg 93:1107-12.
Dudley RA, Johansen KL, Brand R, et al. 2000. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 283:1159-66.
Edwards FH, Peterson ED, Coombs LP, et al. 2001. Prediction operative mortality after valve replacement surgery. J Am Coll Cardiol 37:885-92.
Galloway AC, Grossi EA, Baumann FG, et al. 1992. Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients. J Am Coll Cardiol 19:725-32.
Gammie JS, Chikwe J, Badhwar V, et al. 2018. Isolated mitral valve surgery: The Society of Thoracic Surgeons adult cardiac surgery database analysis. Ann Thorac Surg 106:716-27.
Goodney PP, Siewers AE, Stukel TA, et al. 2002. Is surgery getting safer? National trends in operative mortality. J Am Coll Surg 195:219-27.
Hannan EL, Jones RH, Gold JP, et al. 2000. Predictors of mortality for patients undergoing cardiac valve replacements in New York State. Ann Thorac Surg 70:1212-8.
Hannan EL, Kilburn H Jr, Bernard H, et al. 1991. Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for risk factors. Med Care 29:1094-107.
Hannan EL, O’Donnell JF, Kilburn HJ, et al. 1989. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 262:503-10.
Hassan A, Quan H, Newman A, Ghali WA, Hirsch GM; Team CCOR. 2004. Outcomes after aortic and mitral valve replacement surgery in Canada: 1994/95 to 1999/2000. Can J Cardiol 20:155-63.
Hellgren L, Kvidal P, Stahle E. 2002. Improved early results after heart valve surgery over the last decade. Eur J Cardiothorac Surg 22:904-11.
Jones JM, Lovell D, Cran GW, et al. 2006. Impact of coronary artery bypass grafting on survival after aortic valve replacement. Interact Cardiovasc Surg 5:327-30.
Kang DH, Kim JH, Rim J, et al. 2009. Comparison of early surgery versus conventional treatment in asymptomatic severe mitral regurgitation. Circulation 119:797-804.
Kvidal P, Bergstrom R, Horte LG, et al. 2000. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol 35:747-56.
Lee R, Li S, Rankin JS, et al. 2011. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg 91:677-84.
Litmathe J, Boeken U, Kurt M, et al. 2006. Predictive risk factors in double-valve replacement (AVR and MVR) compared to isolated aortic valve replacement. Thorac Cardiovasc Surg 54:459-63.
Maleszka A, Kleikamp G, Zittermann A, et al. 2008. Simultaneous aortic and mitral valve replacement in octogenarians: a viable option? Ann Thorac Surg 136:82-7.
Murana G, Alfonsi J, Savini C, et al. 2018. On-X mitral valve replacement: a single-center experience in 318 patients. Interact Cardiovasc Thorac Surg doi:10.1093/icvts/ivy184.
Nicolini F, Agostinelli A, Fortuna D, et al. 2014. Outcomes of patients undergoing concomitant mitral and aortic valve surgery: results from an Italian regional cardiac surgery registry. Interact Cardiovasc Thorac Surg 19:763-70.
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.
Noyez L, De Jager MJ, Markou ALP. 2011. Quality of life after cardiac surgery: underresearched research. Interact Cardiovasc Thorac Surg 13:511-5.
Panda BR, Shankar R, Kuruvilla KT, et al. 2009. Combined mitral and aortic valve replacement for rheumatic heart disease: fifteen-year follow up and long-term results. J Heart Valve Dis 18:170-9.
Rankin JS, Badhwar V, He X, et al. 2017. The Society of Thoracic Surgeons mitral valve repair/replacement plus coronary artery bypass grafting composite score: A report of The Society of Thoracic Surgeons quality measurement task force. Ann Thorac Surg 103:1475-81.
Rankin JS, Hammill BG, Ferguson TB, et al. 2006. Determinants of operative mortality in valvular heart surgery. J Thorac Surg 131:547-57.
Ruel M, Chan V, Bedard P, et al. 2007. Very long-term survival implications of heart valve replacement with tissue versus mechanical prostheses in adults <60 years of age. Circulation 116:294-300.
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.
Saxena A, Dinh D, Smith JA, Reid CM, Shardey GC, Newcomb AE. 2013. Excellent short- and long-term outcomes after concomitant aortic valve replacement and coronary artery bypass grafting performed by surgeons in training. J Thorac Cardiovasc Surg 145:334-40.
Stahle E, Kvidal P, Nyström SO, Bergström R. 1997. Long-term relative survival after primary heart valve replacement. Eur J Cardiothorac Surg 11:81-91.
Thourani VH, Weintraub WS, Guyton RA, et al. 2003. Outcomes and long-term survival for patients undergoing mitral valve repair versus replacement: effect of age and concomitant coronary artery bypass grafting. Circulation 108:298-304.
Walther T, Blumenstein J, van Linden A, et al. 2012. Contemporary management of aortic stenosis: Surgical aortic valve replacement remains the gold standard. Heart 98(Supp 4):iv23-9.
Williams SV, Nash DB, Goldfarb N. 1991. Differences in mortality from coronary artery bypass graft surgery at five teaching hospitals. JAMA 266:810-5.
Yan W, Shah P, Hiebert B, et al. 2018. Long-term non-institutionalized survival and rehospitalization after surgical aortic and mitral valve replacements in a large provincial cardiac surgery centre. Interact Cariovasc Thorac Surg 27:131-38.
