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OBJECTIVE: Outcome reporting in valvular surgery has been limited by focusing on specific populations, reluctance to publish high-risk subgroups, and skewed or inadequate samples. This study evaluated risk factors for operative mortality comprehensively, across the entire spectrum of cardiac valvular procedures over the past decade.
METHODS: 409,904 valve patients in the STS database operated between 1994 and 2003 were assessed, and STS preoperative and operative variables were related to hospital mortality using a logistic regression model. Data were >95% complete, and the model had high predictive power with a C statistic of 0.735.
RESULTS: In the Table are shown 19 variables (all p<0.01) influencing operative mortality along with multivariable odds ratios. The most significant variable was non-elective (acute) presentation followed by advanced age, reoperation, endocarditis, and coronary disease. Valve repair was associated with lower mortality than replacement. Female gender was important, and outcomes improved over time. Renal failure or multiple comorbidities could be very significant. Aortic root reconstruction carried the highest risk, followed by tricuspid, multiple valve, and then isolated mitral, pulmonic, and aortic operations. Reduced ejection fraction and severity of valve lesion were less important.
CONCLUSIONS: Thus, acute presentation is the most important variable determining operative mortality in valvular surgery, and earlier elective intervention should be emphasized. Risk issues related to reoperation, endocarditis, valve repair, gender, and the various procedures deserve more detailed examination.