SAVR Heart Surgery Outcomes Improve Even as Population Ages

Mortality rates reflect vast surgical experience

Model of the human heart

If you need surgery for aortic valve disease – you may be worried – wondering what this surgery involves. What are the risks?  Will I survive?  These questions are even more worrisome when you have other medical conditions or need other heart surgery.  But – never fear – your chances for a successful surgery have never been better.

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Aortic valve disease is the most common acquired heart valve disease in elderly patients; with 5 percent of patients over age 80 diagnosed with aortic valve disease, according to Lars Svensson, MD, PhD, Chairman of the Sydell and Arnold Miller Family Heart & Vascular Institute.

As 77 million Baby Boomers retire, Dr. Svensson said the number of patients seeking treatment for this disease will increase. Despite the increase in the proportion of higher-risk patients, Dr. Svensson noted that mortality rates are decreasing for surgical patients.

 Study shows great outcomes

The Society of Thoracic Surgeons (STS) – the professional organization for researchers, surgeons and other health care professionals dedicated to the best outcomes for surgeries of the heart, lung, esophagus and chest -collects data from surgery centers across the nation to improve patient safety and quality of care.  The data helps  predict risk of surgery for adult heart surgery procedures and also serves as a benchmark for national standards for heart surgery care.

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In a study of outcomes after surgical aortic valve replacement (SAVR) in 141,905 patients who underwent first time aortic valve surgery (without other combined procedures) from 2002 to 2010, researchers found that nearly 80 percent of patients have outcomes much better than the STS predicted risk models – a tool for surgeons to predict a patient’s risk of death or illness. Early results from the most recent patients showed further improvement in medium- and high-risk patients.

The reason?

  • Medical teams are doing a better job at evaluating patients before surgery for medical conditions that impact risk of surgery
  • Advances in surgical techniques make surgery safer and improve outcomes
  • Improved intensive care after surgery contribute to improved outcomes in these patients.

“With the introduction of transcatheter aortic valve replacement,  we had to take on patients in research studies we hadn’t always operated on in the past,” Dr. Svensson said. “As we did that, we had to step up our ability technically to deal with more complex operations, and also deal with a much larger geriatric population. We had to learn to deal with fragile tissues in fragile patients, how to get them through the more technically demanding operations and handle poor nutritional reserve – these were all important factors to address.”

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If you need complex valve surgery, experience is important – and Cleveland Clinic surgeons are among the most experienced in the world.  Dr. Svensson noted that mortality rates for isolated aortic valve procedures performed at the Cleveland Clinic in the last four years, irrespective of risk, has been less than 1%, considerably better than STS data.

“We pretty consistently run a risk of death ¼ to 1/3 of the expected mortality rate from the STS calculations,” he said, adding that the average STS hospital site performs 23 aortic valve procedures annually, while the average U.S. surgeon performs eight. In contrast, Cleveland Clinic surgeons perform about 2,600 mitral and aortic valve operations annually. “When it comes to doing complex valve surgery, experience is very important.”

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