Heart Valve Replacements Improving

Aortic valve replacement rates have increased but problems and deaths have decreased

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) Every year, thousands of people have heart valve replacement surgery. Over the past decade, more and more people have been living better after these surgeries.

A recent study looked at thousands of patients in the US that had undergone surgery to replace a valve in their hearts.

The results of the study showed that over 12 years, the number of people having their aortic valve replaced increased. But the rate of death and poor outcomes decreased over the same period of time.

"Talk to your surgeon about your valve replacement options."

José Augusto Barreto-Filho, MD, PhD, of the Federal University of Sergipe in Brazil, lead researchers at the Yale-New Haven Hospital in Connecticut to investigate heart valve replacement in US seniors over the past decade.

The aorta is the biggest artery in the body. The aortic valve is one of four valves located inside the heart, and it separates the left ventricle — the largest chamber of the heart — from the aorta. When the aortic valve does not properly regulate blood flow, a person may need to have the valve replaced with a mechanical valve, a human transplant or a valve made of tissue from a pig, cow or other species.

For this study, the researchers looked at 197,876 Medicare patients in the US who had an aortic valve replacement from 1999 to 2011.

Over the course of 12 years, the rate of aortic valve replacement increased by 19 procedures per 100,000 person years, or 1.6 percent each year. 

Thirty days after surgery, the rate of death decreased by 3.4 percent per year. One year after surgery, the rate of death decreased by 2.6 percent.

For the first 30 days after surgery, the rate for readmission to the hospital for any reason decreased by 1.1 percent per year.

On average, women and black patients were less likely to have a valve replaced compared with men and white patients — but if they did, they had higher rates of death.

With concerns over proper blood clotting, the use of mechanical valves decreased over time. However, in 2011, nearly one-quarter (23.9 percent) of patients 85 and older were still having their valves replaced with a mechanical device.

“Between 1999 and 2011, the rate of surgical aortic valve replacement for elderly patients in the United States increased and outcomes improved substantially,” the study authors wrote.

The study authors recommended that these findings might influence decisions for aortic valve replacement surgery in very senior patients as newer treatments emerge. A transcatheter aortic valve replacement — where a mesh aortic valve is put in place through an artery in the thigh — is a newer, less invasive treatment.

This study was published in November in JAMA.

The National Heart, Lung, and Blood Institute, Yale University, and the Ministry of Education (Brazil) helped support funding for this project. Dr. Krumholz reported a financial relationship with the Centers for Medicare & Medicaid Services, UnitedHealth, and Medtronic.

Review Date: 
November 18, 2013
Last Updated:
November 19, 2013