Better Aortic Valve Replacement Outcomes At High Volume Hospitals

Dr. Christian McNeely, MD Resident Physician, Division of Cardiothoracic Surgery Barnes-Jewish Hospital/Washington University Medical Center St. Louis, Missosuri

Dr. Christian McNeely Interview with:
Dr. Christian McNeely, MD
Resident Physician, Department of Medicine
Barnes-Jewish Hospital/Washington University Medical Center
St. Louis, Missosuri 

MedicalResearch: What is the background for this study? What are the main findings?

Dr. McNeely : Since year 2000, 30-day mortality of aortic valve replacement (AVR) in Medicare beneficiaries has improved. Additionally, mechanical valve use in the elderly, which are often avoided in older patients largely because the risk of bleeding complications outweighs the risk of valve deterioration over time, has fallen significantly. Prior research has demonstrated worse outcomes in cardiac surgery for lower volume centers. Therefore, we sought to investigate the longitudinal relationship between institutional volume and outcomes in AVR using the Medicare database, looking at patients only > 65 years over a 10-year period.

We found that, in general, mechanical valve use in the elderly decreased with increasing hospital volume. Lower volume hospitals exhibited increased adjusted operative mortality. Importantly, the discrepancy in operative mortality between low and high-volume hospitals diverged during the course of the study such that higher volume centers demonstrated significantly greater improvement over time compared to lower volume centers.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. McNeely : Low volume centers were characterized by increased adjusted operative mortality and greater use of mechanical prosthesis in an elderly population. These trends persisted during the 10-year course of the study.

MedicalResearch: What recommendations do you have for future research as a result of this study?

 Dr. McNeely : Further research into defining the factors contributing to worse outcomes for lower volume centers is needed and also to determine if any of these factors are modifiable. Future work should also look into reasons for mechanical valve choice in elderly patients in order to best determine how to address the issue. Additional education and training is also needed for hospitals and health systems with disproportionately higher use of mechanical valves in the elderly.

MedicalResearch: Is there anything else you would like to add?

 Dr. McNeely :Depending on the data source, the use of mechanical valves varies, so each large-scale study has its limitations. Despite this, the present study brings to light that significant mechanical valve use in the elderly still occurs nationwide and is related to institutional volume.


Effect of Hospital Volume on Prosthesis Use and Mortality in Aortic Valve Operations in the Elderly Published Online:September 29, 2015
McNeely, Christian et al.
The Annals of Thoracic Surgery , Volume 101 , Issue 2 , 585 – 590

Dr. Christian McNeely, MD (2016). Better Aortic Valve Replacement Outcomes At High Volume Hospitals

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