title: Regional differences in surgical heart valve disease in Europe: comparison between northern and southern subsets of the EuroSCORE database.
abstract: OBJECTIVE
  Although rates for coronary and valve surgery vary between northern and southern Europe, differences in the features of valve disease leading to surgery in Europe are poorly documented. The study aim was to compare demographics, risk factors, procedures and outcome in valve surgery between European regions, using the EuroSCORE database.
  
  
  METHODS
  Between September and December 1995, information on 98 variables (risk factors, procedures and outcome) were collected on valve surgery patients in 128 European centers. Patients were allocated to two geographic subgroups (north, n = 1,990; south, n = 3,682). The distribution of variables was assessed. Subsequently, the impact of preoperative and operative risk factors on mortality was analyzed in both groups using a bivariate analysis. Risk-adjusted outcomes were then compared according to the EuroSCORE.
  
  
  RESULTS
  Significant differences were identified for clinical features, risk factors and procedures. In northern Europe, surgery was performed on older patients with more severe coronary or associated disease, whilst in the south the cardiac status seemed more severely compromised. Degenerative aortic disease prevailed in the north (aortic valve replacement in 72.7% of cases), whilst in the south mitral surgery accounted for 46.1% of procedures. Despite differences in crude mortality (6.9% north versus 5.7% south), outcomes (when adjusted to risks) seemed comparable (observed-to-expected mortality ratio 0.90 for north versus 0.84 for south). The impact of individual risk factors on mortality was similar, except for atrial fibrillation.
  
  
  CONCLUSIONS
  Despite large epidemiological differences between northern and southern Europe in terms of valve surgery, performances and outcomes were similar when individual risk factors and overall risk profiles were taken into account.
authors.affiliation: Hopital La Meynard, Fort de France, Martinique, French West Indies.
authors.forename: Francois
authors.initials: F
authors.lastname: Roques
authors.forename: Samer A M
authors.initials: SA
authors.lastname: Nashef
authors.forename: Philippe
authors.initials: P
authors.lastname: Michel
mesh_terms: D000368:Aged; D005060:Europe / Q000453:epidemiology; D005260:Female; D006349:Heart Valve Diseases / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome