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Complications following heart valve replacements are prevalent and worsen patient outcomes

Heart valve replacement surgeries account for one in five cardiac procedures and 30 percent of all deaths following cardiac surgeries. Complications contribute substantially to these deaths, according to a new study. Researchers found that over one-third of patients undergoing aortic and mitral valve replacement surgery suffered complications (35.2 and 36.4 percent, respectively).

Patients who suffered any complication had about twice the risk and those with two or more complications had three to four times the risk of dying in the hospital than those without complications. Complications occurred more often among older patients, those with bioprosthetic valves instead of mechanical valves, and among men after mitral valve replacement. Nearly half of the complications were cardiac-related and one-fourth involved hemorrhage, hematoma (pooled blood from a leaking blood vessel), or seroma (mass or swelling due to fluid trapped in the surgical wound).

These complications also increased hospital length of stay and charges, even after adjusting for patient and hospital characteristics, notes Marcia M. Ward, Ph.D., of the University of Iowa. Patients with any complications stayed a median of 3 days longer in the hospital and had $24,000 to $31,000 higher median hospital charges than those without complications. These findings were based on analysis of data from the Nationwide Inpatient Sample on hospitalized patients for years 2000-2003. A total of 43,909 patients (most in their sixties) underwent aortic valve replacement and 16,516 underwent mitral valve replacement.

The study was supported in part by the Agency for Healthcare Research and Quality (HS15009).

More details are in "Impact of complications on outcomes following aortic and mitral valve replacements in the United States," by Veerasathpurush Allareddy, Ph.D., Dr. Ward, John W. Ely, M.D., and James Levett, M.D., in the June 2007 Journal of Cardiovascular Surgery 48(3), pp. 349-356.

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