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Valve Replacement - Better than it used to be

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ElectLive

Well-known member
Joined
Jun 26, 2011
Messages
631
Location
Atlanta, GA
We're lucky here to have the perspective and input of a few "veterans" who had a valve replacement 10, 20, and even 40+ years ago. They sometimes share very enlightening stories of just how different the surgery was then, as well as the related treatments such as ACT. Now, certainly the technology and methods are better now, and the risks are lower too. But it's reasonable to wonder if valve replacement surgery, as we currently know it, is approaching the endpoint of diminishing returns, and just really isn't getting safer anymore. Well, I won't speculate on what will happen in the next ten years, because in many ways that will be impacted as much by alternative methods, but I did find some interesting stats from the STS National Database (the composite results of all patients, risk groups, etc) over the last 10 years that I thought were worth sharing:

Operative mortality for isolated AVR declined from 3.4% in 2002 to 2.6% in 2011.
The risk of in-hospital permanent stroke after AVR decreased from 1.7% in 1996 to 1.3% in 2006.
Operative mortality for AVR plus CAB declined from 6.2% in 2002 to 4.4% in 2011.
Operative mortality for AVR plus MVR declined from 11.0% in 2002 to 7.3% in 2011.
Operative mortality for tricuspid valve procedures declined from 10.1% in 2002 to 7.7% in 2011.

Now, let me just emphasize again that these are composite results, all risk groups. Many of us are quoted risk numbers even lower, much lower in some cases.

As for the results, there definitely is a pattern of improvement for these procedures over the last ten years. So, I see that as very good news. Perhaps the improvement over the next 10 years may not be as significant, but good at least to see tangible evidence that current surgical methods are in fact getting safer. By the way, isolated bypass surgery is showing very much the same pattern too, so for those that have that additional condition, equally good news.

The source for these numbers is here: http://www.sts.org/sites/default/files/documents/20112ndHarvestExecutiveSummary.pdf. Interestingly, for isolated mitral and pulmonic procedures, it shows much more of an up and down progression, not as identifiable a pattern. I can't explain that, perhaps someone else may have an idea.

So, I know this has been a lot of mostly boring numbers, but for all those in the Waiting Room, please take this as some reassurance that valve replacement surgery is not only already very safe, but it is still getting better.
 
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