title: Five-year epidemiological survey of valvular heart disease: changes in morbidity, etiological spectrum and management in a cardiovascular center of Southern China.
abstract: OBJECTIVE
  The objective of the present study is to analyze the epidemiological profile of patients with abnormal valvular structure and function and highlight the etiological spectrum and management of valvular heart disease (VHD) in a single cardiovascular center of Southern China in five years.
  
  
  METHODS
  The retrospective study included 19,428 consecutive patients (9,441 men and 9,987 women with a mean age of 52.03±20.50 years) with abnormal valvular structure and function who were screened by transthoracic echocardiography (TTE) or transesophageal echocardiography (TEE) at the in-patient department of Guangdong General Hospital from January 2009 to December 2013. Data on baseline characteristics, potential etiology, treatment strategies and discharge outcomes were collected from electronic medical records.
  
  
  RESULTS
  There were 13,549 (69.7%) patients with relatively definite etiology for VHD. VHD was rheumatic in 7,197 (37.0%) patients, congenital in 2,697 (13.9%), degenerative in 2,241 (11.5%), ischemic in 2,460 (12.7%). The prevalence decreased significantly in rheumatic VHD from 2009 to 2013 (from 42.8% to 32.8%, P<0.001), but increased markedly in congenital VHD (from 9.0% to 12.3%, P<0.001), ischemic VHD (from 9.2% to 11.3%, P=0.003) and degenerative VHD (from 8.8% to 14.5%, P<0.001). Meantime, the prevalence of ischemic VHD increased after the age of 45, similar to that of degenerative VHD. From 2009 to 2013, the proportion of patients with VHD undergoing open cardiac valvular surgery decreased (from 49.5% to 44.3%, P<0.001) and that of patients treated with general medication increased (from 49.2% to 54.1%, P<0.001). However, there was markedly increment in video-assisted thoracoscopic surgery (VATS) from 2009 to 2013 (from 0.3% to 4.4%, P<0.001). Increasing tendencies were showed in aortic mechanical valve replacement (from 32.1% to 34.5%, P=0.001) and double mechanical valve replacement (from 20.9% to 22.3%, P=0.035), especially in mitral valvuloplasty (from 8.5% to 15.7%, P<0.001). However, the proportion of patients undergoing bioprosthetic valve replacement decreased from 2009 to 2013 (from 26.3% to 15.5%, P<0.001).
  
  
  CONCLUSIONS
  Despite a significant shift from rheumatic towards degenerative etiology from 2009 to 2013, rheumatic VHD remains the leading etiology in Southern China, with a significant increase in the prevalence of ischemic, congenital and degenerative VHD. General medication and cardiac valvular surgery remain the main treatment options. The proportion of VATS increased markedly from 2009 to 2013, and mechanical valve replacement and mitral valvuloplasty showed an increasing tendency.
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Fang-Zhou
authors.initials: FZ
authors.lastname: Liu
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Yu-Mei
authors.initials: YM
authors.lastname: Xue
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Hong-Tao
authors.initials: HT
authors.lastname: Liao
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Xian-Zhang
authors.initials: XZ
authors.lastname: Zhan
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Hui-Ming
authors.initials: HM
authors.lastname: Guo
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Huan-Lei
authors.initials: HL
authors.lastname: Huang
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Xian-Hong
authors.initials: XH
authors.lastname: Fang
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Wei
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Rao
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Deng
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Liu
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Lin
authors.affiliation: 1 Guangdong Cardiovascular Institute, Guangdong Province Key Laboratory of Structural Heart Disease, 2 Research Center of Medical Science, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
authors.forename: Shu-Lin
authors.initials: SL
authors.lastname: Wu
keywords: Epidemiological; cardiac valvular surgery; etiology; valvular heart disease (VHD)