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A profile of valve replacement surgery in the UK (1986-1997): a study from the UK Heart Valve Registry
1Imperial College School of Medicine, Science and Technology, London, United Kingdom.
Insights
The UK Heart Valve Registry (UKHVR) tracked over 58,000 heart valve replacements from 1986-1997, revealing significant shifts in patient demographics and valve choices. This comprehensive analysis highlights evolving trends in cardiac surgery and patient outcomes over an 11-year period.
Area of Science:
- Cardiovascular Surgery
- Medical Device Technology
- Public Health Surveillance
Background:
- Heart valve replacement (VR) is a critical procedure, with approximately 150,000 implanted globally each year.
- The UK performs about 4% of these global heart valve implantations.
- The UK Heart Valve Registry (UKHVR) provides a robust dataset for analyzing VR trends.
Purpose of the Study:
- To comprehensively profile trends in VR surgery in the UK from 1986 to 1997.
- To analyze changes in patient demographics, valve selection, and surgical patterns.
- To assess outcomes and survival rates associated with VR procedures.
Main Methods:
- Utilized the UK Heart Valve Registry (UKHVR), a prospective computerized database of all UK cardiac units.
- Tracked patients via national agencies for mortality data, ensuring comprehensive follow-up.
- Analyzed data for 58,195 first-time VR surgeries and 63,649 valve implants between 1986 and 1997.
Main Results:
- Patient age at VR surgery increased significantly, from a mean of 58.7 years in 1986 to 64.7 years in 1997.
- The proportion of patients over 70 undergoing VR surgery rose from 12% to 36% during the study period.
- 30-day mortality decreased from 6.9% in 1986 to 3.8% in 1995, with a subsequent rise to 6.7% by 1997. Actuarial survival at 10 years was 61.8%.
Conclusions:
- UKHVR data enables detailed trend analysis of over 63,000 heart valves.
- Significant changes observed in patient demographics, valve choice (increased bileaflet mechanical valves), and heart valve disease patterns.
- The registry provides valuable insights into the evolution of heart valve surgery in the UK over 11 years.
Background And Aim Of The Study:
Approximately 150,000 heart valves are implanted annually world-wide, of which 4% are implanted in the UK. We present a comprehensive profile of the trends in valve replacement (VR) surgery in the UK since 1986 based on data from the UK Heart Valve Registry (UKHVR).
Methodology:
The UKHVR is a computerized database collecting prospective data on VR surgery in all UK cardiac units. All patients are tracked by national agencies who register all deaths of UK residents. Thus, the Registry receives a copy of each patient's death certificate and enters the date, place and certified cause(s) of death on the database.
Results:
Between January 1st 1986 and December 31st 1997, a total of 58,195 patients underwent first-time VR surgery and received 63,649 valves. Mean age at operation in 1986 was 58.7 years (range: 18-87 years) and this rose to 64.7 years (range: 18-94 years) in 1997. In 1986, 12% (n = 578) of patients who underwent VR surgery were aged >70 years compared with 36% (n = 5125) in 1997. There was a 4% decrease in double VR surgery and a 15% reduction in mitral VR between 1986 and 1997. The majority of patients received a mechanical valve; within this group the number of bileaflet valve implants increased significantly since 1986. There has been a reversal in the downward trend in pericardial valves implanted since 1993. Follow up was 96.1% complete, with a total of 342,993 patient-years. Mortality (30-day) fell from 6.9% in 1986 to 3.8% in 1995, but increased to 6.7% in the two years to 1997. Actuarial survival at 1, 5 and 10 years was 89.5%, 78.5% and 61.8%, respectively; confidence intervals of 0.5% reflect the enormity of the database and quality of the data.
Conclusions:
UKHVR data can provide comprehensive year-by-year and trend analyses in a database in excess of 63,000 valves. Changes in patient demographics, choice of implanted valve and the pattern of heart valve disease are evident within the UK over the past 11 years.