Trends and outcomes of valve surgery in The Netherlands
Patient demographics The mean age in mitral valve surgery (repair or replacement) with and without concomitant CABG, increased slightly over the years from 63.8Âą11.7 in the first four years of the registry (1995 to 1998) to 65.8Âą11.4 in the last four years of the registry (2007 to 2010) (p < 0.001) (Figure 7) [source 1]. No trend in logistic EuroSCORE between 2007 and 2010 could be detected (median logistic EuroSCORE 5.5%, IQR 2.9-10.6, p = 0.917) [source 2]. Outcomes In-hospital mortality for mitral valve surgery (repair or replacement) with or without concomitant CABG did not change over the years 2007 to 2010 (4.3%, 4.5%, 3.9%, 4.2%, p = 0.626) [source 2]. Mitral valve reconstruction was associated with a considerably lower operative risk than mitral valve replacement according to the EuroSCORE. Accordingly, a lower early mortality rate was found: 2.7% in-hospital mortality and a median logistic EuroSCORE of 4.9% for repair surgery, versus 8.6% in-hospital mortality and a median logistic EuroSCORE of 7.5% for mitral valve replacement (Table 2). Survival up to four years after surgery showed similar results (Figure 4). The reoperation rate after three years was 2.6% for mitral valve repair and 3.6% for mitral valve replacement with or without CABG (Figure 5) [source 3].
Discussion Primary findings This is the first time that procedural volumes and trends, patient characteristics, survival, cause of death, reoperation rates, readmission rates and other information have been gathered for a variety of heart valve operations in a national database. The findings help us understand the developments that have been taking place in the rapidly evolving field of valve surgery and provide indispensable knowledge for clinicians, governing bodies and policy makers in healthcare. In the past 16 years there has been a spectacular increase in the number of heart valve operations performed in The Netherlands: from 20 operations in 1995 to 43 operations in 2010, per 100,000 adults. Despite no apparent change in patient risk profile, in-hospital mortality of all valve surgery has decreased significantly over the last five years. This suggests that the trend of improved outcomes and safer surgery has continued up to this day. In addition, scientific evidence might have changed our view over the years: the age at which clinicians start to consider a bioprosthetic valve has decreased and mitral valve surgery is currently dominated by repair instead of replacement. Mitral valve replacement did not result in lower valve-related reoperation rates in the first four years after surgery. Although survival after all valve surgery was satisfactory, the number of readmissions in the first year
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