Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery

Ann Thorac Surg. 2004 Feb;77(2):549-56. doi: 10.1016/S0003-4975(03)01585-6.


Background: Risk factors for 30-day operative (short-term) mortality following coronary artery bypass graft (CABG only) procedures are well established. However, little is known about how the risk factors for short-term mortality following valve replacement procedures (with or without a CABG procedure performed) compare with CABG only risk factors.

Methods: Department of Veterans Affairs (VA) records (65,585 records) were collected from October 1991 through March 2001 and analyzed. Risk factors for short-term mortality were compared across three subgroups of patients: CABG only surgery (n = 56,318), aortic valve replacement (AVR) with or without CABG (n = 7450), and mitral valve replacement (MVR) with or without CABG (n = 1817). Multivariable logistic regression analyses were used to compare the relative magnitude of risk for 19 candidate predictor variables across subgroups.

Results: Only three patient baseline characteristics differed significantly in magnitude of risk between the procedure groups. Partially or totally dependent functional status significantly increased the risk of short-term mortality for AVR patients (odds ratio [OR] 1.64, 95% confidence interval [CI] 1.29-2.09) and MVR patients (OR 2.21, 95% CI 1.48-3.30), but not for CABG only patients (OR 1.04, 95% CI 0.93-1.16). Conversely, previous heart surgery and New York Heart Association functional class III or IV symptoms conferred greater magnitude of risk for CABG only patients compared with the valve subgroups.

Conclusions: Overall, the risk factors for short-term mortality following valve replacement and CABG surgery appear to be relatively consistent. However, clinicians should be aware of the importance of preoperative functional status as a unique predictor of mortality following valve surgery.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Aortic Valve / surgery
  • Combined Modality Therapy / mortality
  • Confidence Intervals
  • Coronary Artery Bypass / mortality*
  • Female
  • Follow-Up Studies
  • Heart Valve Prosthesis Implantation / mortality*
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / surgery
  • Models, Statistical
  • Multivariate Analysis
  • Odds Ratio
  • Postoperative Complications / mortality*
  • Risk Factors
  • Survival Analysis
  • Veterans / statistics & numerical data