Related Experiment Video
Updated: Aug 29, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Comparison of short-term mortality risk factors for valve replacement versus coronary artery bypass graft surgery
Sheila C Gardner1, Gary K Grunwald, John S Rumsfeld
1Department of Veterans Affairs Medical Center, Denver, Colorado, USA.
Insights
Risk factors for short-term mortality after heart surgery are similar for coronary artery bypass graft (CABG) and valve replacement. Preoperative functional status is a key predictor for valve surgery mortality.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Outcomes Research
Background:
- Established risk factors for short-term mortality exist for coronary artery bypass graft (CABG) only procedures.
- Limited understanding of how risk factors for short-term mortality in valve replacement procedures (with or without CABG) compare to CABG-only procedures.
Purpose of the Study:
- To compare risk factors for short-term mortality between CABG-only surgery and valve replacement surgery (aortic valve replacement [AVR] or mitral valve replacement [MVR]), with or without concomitant CABG.
Main Methods:
- Analysis of 65,585 Department of Veterans Affairs (VA) records from October 1991 to March 2001.
- Comparison of risk factors across three patient subgroups: CABG only (n=56,318), AVR +/- CABG (n=7450), and MVR +/- CABG (n=1817).
- Multivariable logistic regression used to compare the relative risk magnitude of 19 candidate predictor variables.
Main Results:
- Partially or totally dependent functional status significantly increased short-term mortality risk for AVR (OR 1.64) and MVR (OR 2.21) patients, but not CABG-only patients (OR 1.04).
- Previous heart surgery and New York Heart Association functional class III/IV symptoms posed a greater mortality risk for CABG-only patients compared to valve subgroups.
Conclusions:
- Risk factors for short-term mortality are generally consistent between valve replacement and CABG surgery.
- Preoperative functional status is a critical and unique predictor of mortality specifically for valve surgery patients.
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.
