Valve Disease. Valve Surgery. In 2015, Cleveland Clinic surgeons performed 2943 valve surgeries.

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1 Valve Surgery Volume N = In 15, surgeons performed 93 valve surgeries. surgeons have implanted more than 1,5 bioprosthetic aortic valves since the 199s, with excellent short- and long-term outcomes. Outcomes 15

2 Primary Operation and Reoperation Volume (N = 93) 15 Volume Primary Operation Reoperation surgeons performed 93 valve procedures in 15. A total of 199 were primary operations and 7 were reoperations (5%). Primary Operation and Reoperation In-Hospital Mortality (N = 93) 15 Primary Operation Reoperation Patients who have valve surgery reoperations have a somewhat higher risk of death compared with patients who have a primary operation, due to the overall decrease in health over time. Despite this, the in-hospital mortality rates were lower than expected for both reoperations and primary procedures. Source: Data from the Vizient Clinical Data Base/Resource Manager TM used by permission of Vizient. All rights reserved. Sydell and Arnold Miller Family Heart & Vascular Institute 9

3 In-Hospital Mortality by Type (N = 93) Surgical Isolated AVR Transcatheter AVR AVR + CABG % Isolated MVR % % MVR + CABG Isolated MV Repair Septal Myectomy a N = STS expected The 15 in-hospital mortality rates for all types of valve surgery at were lower than expected. AVR = aortic valve replacement, CABG = coronary artery bypass grafting, MV = mitral valve, MVR = mitral valve replacement a These valve surgery cases do not have established STS expected mortality rates due to the complexity of the procedures. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 15 Aortic Valve Surgery Volume 15 In 15, 193 aortic valve procedures were performed at. 1 5 N = Outcomes 15 3

4 STS Rating for Aortic Valve Replacement June 1 June 15 ranked among the top % of US hospitals for aortic valve replacement (AVR) surgery, earning the Society of Thoracic Surgeons (STS) 3-star rating for this category. This denotes the highest category of quality. Participant Score (95% Confidence Interval) STS Mean Participant Score Participant Rating 97.% 9.7% (9., 97.9) STS Min.3 1th 9.1 5th th 97. Max 9.5 = STS mean participant score Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 15 Isolated Aortic Valve Replacement Complications (N = ) 15 1 STS expected % Deep Sternal Wound Infection Postop Stroke Postop Renal Failure Postop Reoperation (Any) had lower-than-expected rates of complications for isolated aortic valve replacement surgery. Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 15 Sydell and Arnold Miller Family Heart & Vascular Institute 31

5 STS Rating for Coronary Artery Bypass Grafting and Aortic Valve Replacement June 1 June 15 ranked among the top.3% of US hospitals for coronary artery bypass graft (CABG) surgery plus aortic valve replacement (AVR), earning the Society of Thoracic Surgeons (STS) 3-star rating for this category (based on data from July 1 through June 15). This denotes the highest category of quality. Participant Score (95% Confidence Interval) STS Mean Participant Score Participant Rating 95.5% 91.7% (9., 9.3) STS Min 79. 1th.3 5th 9.1 9th 9.7 Max 97.1 = STS mean participant score Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 15 Combined Coronary Artery Bypass Grafting and Aortic Valve Replacement In-Hospital Mortality (N = 1) 15 1 N = Primary Operation 1 Reoperation 3 STS expected Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 15 Aortic valve replacement, in combination with coronary artery bypass graft (CABG) surgery, is a complex operation. Despite this complexity and the associated increase in risks, in-hospital mortality rates for both primary operations and reoperations were low. 3 Outcomes 15

6 Mitral Valve Surgery Volume, Repair vs Replacement Repair Replacement performs mitral valve repair procedures rather than replacement whenever possible. Mitral valve repair is associated with better survival, improved lifestyle, better preservation of heart function, and a lower risk of stroke and infection (endocarditis) compared with mitral valve replacement. Repair procedures also do not require postprocedure anticoagulation therapy. Isolated Mitral Valve Surgery In-Hospital Mortality (N = 13) 15 STS expected The 15 in-hospital mortality rates for patients who had isolated mitral valve surgery were lower than expected for both repair and replacement procedures. % Replacement Repair N = 9 3 Source: Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database 15 As world leaders in mitral valve repairs, surgeons performed robotically assisted mitral valve surgery on 1 patients from to 1. The mortality rate was.1% (N = 1). Source: Gillinov AM, Mihaljevic T, Javadikasgari H, Suri R, Mick S, Navia J, Desai M, Bonatti J, Khosravi M, Idrees J, Lowry A, Blackstone E, Svensson L. Safety and Effectiveness of Robotically Assisted Mitral Valve Surgery: Analysis of 1, Consecutive Cases. Paper presented at: American Association for Thoracic Surgery Annual Meeting; May 1-1, 1. Baltimore, MD. Sydell and Arnold Miller Family Heart & Vascular Institute 33

7 Surgical Treatment of Active Infective Endocarditis Primary Operation, In-Hospital Mortality Observed The in-hospital mortality rates for patients who had primary operations for infective endocarditis were lower than expected in N = % Source: Data from the Vizient Clinical Data Base/Resource Manager TM used by permission of Vizient. All rights reserved. Reoperation, In-Hospital Mortality Observed The in-hospital mortality rates for patients who had reoperations for infective endocarditis were lower than expected in N = Source: Data from the Vizient Clinical Data Base/Resource Manager TM used by permission of Vizient. All rights reserved. 3 Outcomes 15

8 Transcatheter Aortic Valve Replacement is a national leader in the use of percutaneous treatment options for patients with valve disease. Volume and In-Hospital Mortality Volume N = Mortality (%) 1 1 Observed N = A total of 33 patients had transcatheter aortic valve replacement (TAVR) procedures at in 15. The in-hospital mortality rate was.3% compared with an expected rate of 7.%. Source: Data from the Vizient Clinical Data Base/Resource Manager TM used by permission of Vizient. All rights reserved. Since the inception of the transcatheter aortic valve replacement (TAVR) program in, has become a world leader in the use of this specialized treatment in patients carefully selected based upon stringent clinical criteria. A total of 1 patients have had this procedure done from 1 to 15, and the in-hospital mortality rate was 1.7% compared with the expected rate of 7.7%. Source: STS/ACC TVT Registry Sydell and Arnold Miller Family Heart & Vascular Institute 35

9 In-Hospital Mortality (N = 1) 1 15 began its transcatheter aortic valve replacement (TAVR) program in. From 1 to 15, 1 TAVR procedures have been performed with a lower-than-expected mortality rate (1.7% vs 7.7%). Source: Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapy (TVT) Registry Volume by Approach (N = 75) 1 15 Of the 75 TAVR procedures performed from 1 through 15, 73% have been done using a transfemoral approach. 1% 73% transfemoral (N = 39) 17% transapical (N = 1) 7% transaortic (N = 3) % other (transaxillary, transcarotid) (N = 15) 1% subclavian (N = 1) 3 Outcomes 15