title: Fifteen-year outcome trends for valve surgery in North America.
abstract: BACKGROUND
  Although results in valvular heart surgery may be improving, too few cases are available in most centers to quantify changes, especially for uncommon procedural categories. This study examined comprehensively national trends in valve surgery outcomes over the past 15 years.
  
  
  METHODS
  From 1993 through 2007, 623,039 valve procedures were grouped into single aortic (A), mitral (M), and tricuspid (T) operations, along with AM, MT, AT, and AMT multiple valves ± coronary artery bypass graft surgery. Pulmonary valve surgery was excluded. Trends in baseline characteristics were documented, and logistic regression adjusted for differences in patient profiles. Outcomes were expressed as unadjusted operative mortality, adjusted odds ratios for mortality, and a composite of mortality and major complications.
  
  
  RESULTS
  Single valves comprised 89% of valve surgery and multiple valves, 11%. Preoperative patient risk profiles worsened over time. Mortality rates were higher for multiple valves, but all mortality rates fell significantly over the 15 years (p <0.001). The composite of mortality and major morbidity did not improve, however, largely because of increasing pulmonary/infectious complications. Overall, cardiac etiology accounted for 54% of deaths, and pulmonary/infectious etiologies for 16%. Cardiac etiology of death fell by 16% over time, but pulmonary death and complications increased by 78% and 39%, respectively.
  
  
  CONCLUSIONS
  Preoperative patient profiles for cardiac valve procedures have worsened over time. Risk-adjusted mortalities have fallen for all valve surgery, but remain higher for multiple valves. The finding of increasing pulmonary deaths and complications suggests that prevention and improved management of pulmonary and infectious complications could be an important focus for quality improvement.
authors.affiliation: Northwestern University Medical Center, Chicago, Illinois, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.forename: J Scott
authors.initials: JS
authors.lastname: Rankin
authors.forename: Sean M
authors.initials: SM
authors.lastname: O'Brien
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
authors.forename: Fred H
authors.initials: FH
authors.lastname: Edwards
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000401:mortality / Q000639:trends*; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D009656:North America / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors