Valve Disease. Valve Surgery Volume (N = 2852)

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1 Valve Disease Valve Surgery 13 (N = 85) In 13, surgeons performed 85 valve surgeries. A total of 59 were primary operations and 793 were reoperations. Comparative Valve 13 3 STS average volume 1 AVR MVR AVR + CABG MV repair is the nation s leader for valve surgery volume. Abbreviations: AVR, aortic valve replacement; CABG, coronary artery bypass grafting; MV, mitral valve; MVR, mitral valve replacement Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database, Outcomes 13

2 Valve Surgery In-Hospital Mortality Distribution of Isolated and Combined Valve Operations (N = 85) 13 1% Isolated AVR STS expected AVR + CABG % % Isolated MVR MVR + CABG Isolated MV repair 5% Isolated primary valve surgeries (N = 7) 7% Combined primary valve surgeries (N = 1355) Septal myectomy N = The 13 mortality rates for all types of valve surgery were lower than expected at. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database, 13. Abbreviations: AVR, aortic valve replacement; CABG, coronary artery bypass grafting; MV, mitral valve; MVR, mitral valve replacement recently received The Society of Thoracic Surgeons (STS) prestigious three-star rating for aortic valve replacement and AVR+CABG. The rating is awarded to hospitals across the country that demonstrate the highest quality of cardiac surgery. was awarded the rating based on data comparisons from January December 13. 9% Isolated valve reoperations (N = 5) 19% Combined valve reoperations (N = 537) 8% The majority of valve procedures performed at in 13 were combined primary procedures. Reoperations made up 8% of all valve procedures. Sydell and Arnold Miller Family Heart & Vascular Institute 9

3 Valve Disease (continued) Aortic Valve Surgery 13 (N = 1757) AV-sparing AV repair AV replacement The volume of aortic valve (AV) procedures performed at continues to increase. In 13, a total of 1757 procedures were done. The majority (N = 159) were valve replacements. Surgeons performed a total of 11 valve-sparing and 17 valve repair procedures. Combined Aortic Valve Replacement Mortality 13 Primary Reoperation STS expected Aortic valve replacement, in combination with other surgical procedures, is a complex operation. Despite this complexity and the associated increase in risks, mortality rates for both primary and reoperations were low. Source: These data are prepared using the University HealthSystem Consortium (UHC) Clinical Database. uhc.edu 3 Outcomes 13 3

4 Isolated Aortic Valve Replacement Complications STS expected % Deep sternal wound infection Postop stroke Postop renal failure Postop reoperation (any) The complication rates associated with isolated aortic valve replacement were lower than expected for all complications. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database, 13. Mitral Valve Surgery (N = 18) Replace Repair surgeons performed 18 mitral valve surgeries in 13. The majority (7%) were valve repair procedures and 3% were valve replacements. Sydell and Arnold Miller Family Heart & Vascular Institute 31

5 Valve Disease (continued) Mitral Valve Surgery Repair vs Replacement Repair Replacement performs mitral valve repair procedures rather than replacement whenever possible. Mitral valve repair is associated with better survival, improved lifestyle, better preservation of heart function, and a lower risk of stroke and infection (endocarditis) compared with mitral valve replacement. Repair procedures also do not require postprocedure anticoagulation therapy. Isolated Mitral Valve Surgery Hospital Mortality 13 STS expected Replace % Repair In 13, the mortality rates for patients who had isolated mitral valve surgery were lower at than the expected rates for both repair and replacement procedures. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database, Outcomes 13

6 Surgical Treatment of Infective Endocarditis Bacterial (infective) endocarditis is a life-threatening infection of the heart valves or the heart s inner lining (endocardium). The condition causes growths on or holes in the valves or scarring of the valve tissue, most often resulting in a leaky heart valve. surgeons treat patients with infective endocarditis, including those with advanced disease and prosthetic valve endocarditis. and Hospital Mortality Primary Reoperation In 13, surgeons performed 13 valve procedures to treat patients with infective endocarditis. A total of 7 were primary operations (in-hospital mortality rate, %) and were reoperations (in-hospital mortality rate, 8.3%). Infective Endocarditis Primary Hospital Infective Endocarditis Reoperation Mortality (N = 7) Hospital Mortality (N = ) Observed Expected 15 1 Observed Expected % % 13 Source: These data are prepared using the University HealthSystem Consortium (UHC) Clinical Database. uhc.edu 33 Sydell and Arnold Miller Family Heart & Vascular Institute 33

7 Valve Disease (continued).8% Hospital Mortality The hospital mortality rate for robotically assisted valve surgeries was.8% in 13. The expected rate was 1.%. Source: These data are prepared using the University HealthSystem Consortium (UHC) Clinical Database. uhc.edu Percutaneous Mitral Valvuloplasty and Hospital Mortality Mortality (%) Seven patients had percutaneous mitral valvuloplasty at in 13. surgeons consistently maintain a % mortality rate for this procedure. 1 Robotically Assisted Mitral Valve Repair 9 13 Of the 133 robotically assisted mitral valve repair procedures in 13, a total of 13 were mitral valve repairs. The in-hospital mortality rate for these procedures was.8% compared to an expected mortality rate of 1.% Outcomes 13

8 Transcatheter Aortic Valve Replacement is a national leader in the use of percutaneous treatment options for patients with valve disease. Transcatheter Aortic Valve Replacement and Hospital Mortality Mortality (%) Observed Expected A total of 187 patients had transcatheter aortic valve replacement (TAVR) procedures at in 13. The in-hospital mortality rate was.1% compared with an expected rate of.%. is one of the nation s leading hospitals for this procedure. The technique is currently approved for use in certain patients, and further research is being conducted to assess use in other patient populations. Source: Mack MJ, Brennan J, Brindis R, et al. Outcomes Following Transcatheter Aortic Valve Replacement in the United States. JAMA. 13;31(19):9-77. doi:1.11/jama PARTNER II Trial is currently recruiting patients for the second arm of the Placement of Aortic Transcatheter Valves (PARTNER II) trial. This phase involves a randomized study of patients who have a moderately high risk associated with traditional surgery to treat severe aortic stenosis. Researchers are studying the use of percutaneous aortic valve replacement in this patient population. The procedure is done through the transfemoral or left subclavian artery or via a transapical approach. Research also includes an approach through the ascending aorta via a mini-j incision. Sydell and Arnold Miller Family Heart & Vascular Institute 35

9 Valve Disease (continued) TAVR and Hospital Mortality, by Approach (N = 187) Transfemoral % Transapical Mortality (%) 5 Other 3 1 TF TA Transfemoral (TF) Transapical (TA) The TAVR procedure can be performed via a transfemoral or transapical approach. In 13, doctors used the transfemoral approach in 113 procedures (in-hospital mortality,.7%). The transapical approach was used in 5 procedures (in-hospital mortality, %). Other approaches are being researched. Transfemoral Aortic Valve Replacement and 3-Day Mortality Mortality (%) was one of the first hospitals to perform the TAVR procedure. The femoral approach has been consistently associated with low mortality. TAVR is used to treat some of the most critically ill patients with aortic valve disease. 3 Outcomes 13

10 Valve Surgery and Incidence of Reoperation First surgery 1st nd 3rd Reoperations th+ surgeons performed 85 valve procedures in 13. The majority were first operations. Valve Surgery Reoperation Inpatient Mortality 13 8 Expected 1st % % nd 3rd th+ Reoperations Valve surgery reoperations are associated with a somewhat increased risk of death due to patients decreased overall health over time. Despite the increased risk, had lower than expected inpatient mortality rates in 13. Source: These data are prepared using the University HealthSystem Consortium (UHC) Clinical Database. uhc.edu Sydell and Arnold Miller Family Heart & Vascular Institute 37