The results of cardiac valve procedures

Valvular procedures have become increasingly safe and efficacious. The number of procedures and prostheses that are available increases each year. However, a precise comparison of alternative treatments for patients with valvular heart disease requires an accurate and unbiased recording of the results. The American Association for Thoracic Surgery and the Society of Thoracic Surgeons have developed guidelines that are intended to permit a comparison of alternative procedures and prostheses employed in the treatment of patients with valvular heart disease. These guidelines have been followed by most recent reports and have greatly facilitated the comparison of alternative treatment strategies. Reports evaluating the long-term effects of valvular heart surgery should carefully state the population from which the sample was taken, the adequacy of the follow-up, and the closing interval employed. Every attempt should be made to document the causes of death or other adverse events, because if they are not adequately documented they must be assumed to be valve related. Recent studies have demonstrated that age was the major predictor of structural valve failure at 10 years after bioprosthetic implantation. To avoid bioprosthetic failure some surgeons have employed a stentless porcine aortic valve or a homograft prosthesis. Both of these approaches will require the test of time. To compare alternative treatments, definitions and reporting techniques must be uniform. The guidelines have been adopted by most authors reporting the long-term results of valve procedures.