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A Comparative Study on Surgical Treatment of Valvular Heart Disease between High-Volume Cardiac Centers in China and
Hongyuan Lin1, Jiamiao Gong1, Yongjian Wu1
1Cardiac Surgery Center, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Insights
Chinese valvular surgery (CCSR) shows improving trends and comparable quality to US data (STS), despite some areas needing improvement. Key procedures like mitral valve repair are increasing, with lower mortality rates overall.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Comparative Effectiveness
Background:
- Valvular heart disease management varies globally.
- The Chinese Cardiac Surgery Registry (CCSR) captures national data.
- The Society of Thoracic Surgeons (STS) database provides US benchmarks.
Purpose of the Study:
- To compare valvular surgery trends and outcomes between China (CCSR) and the US (STS).
- To assess the quality of care in Chinese cardiac surgery hospitals.
- To identify areas for improvement in Chinese valvular surgery practices.
Main Methods:
- Analysis of 34,386 valvular surgery cases from the CCSR (2016-2018).
- Comparison of procedure proportions, volume changes, mortality, and complication rates with STS data.
- Statistical analysis of in-hospital mortality and major postoperative complications.
Main Results:
- Divergent trends in valvular heart disease features and operation volume observed between CCSR and STS.
- Mitral valve (MV) repair proportion lower in CCSR (13.7%) but shows an upward trend.
- CCSR procedures had lower mortality (2% vs. 2.6%) and stroke (0.5% vs. 1.6%) but higher prolonged ventilation (22.4% vs. 10.4%) and renal failure (5.6% vs. 3.2%) rates than STS.
Conclusions:
- Valvular surgery quality in leading Chinese hospitals is comparable to the US.
- China demonstrates progress in valvular surgery, particularly in MV repair volume.
- Specific areas like prolonged ventilation and renal failure require focused improvement in China.
Abstract:
The goal of this study is to summarize valvular surgery data from the Chinese Cardiac Surgery Registry (CCSR) and compare it to the most recent data from the Society of Thoracic Surgeons (STS). From 2016 to 2018, a total of 34,386 cases of the seven most common valvular surgical procedures was obtained from the CCSR. We calculated the proportions of different procedures in the CCSR cohort (n = 34,386) as well as the change in operation volume for each procedure. We also compiled rates of postoperative in-hospital mortality and five major complications across all procedures. All of the results were compared to the STS data. The CCSR and STS data showed divergent trends in valvular heart disease features and operation volume. Although the proportion of MV repair in the CCSR (13.7%) data was lower than in the STS data (23.2%), it demonstrated a substantial upward trend. In terms of operation volume, the CCSR data showed an upward trend, but the STS data showed a downward trend. CCSR procedures showed lower mortality (2% vs. 2.6%), reoperation (2.8% vs. 4.3%), and permanent stroke (0.5% vs. 1.6%) rates than STS procedures but higher rates of prolonged ventilation (22.4% vs. 10.4%) and renal failure (5.6% vs. 3.2%). Valvular surgery quality in China's leading cardiac hospitals is roughly comparable to that in the United States. China, on the other hand, has some shortcomings that need improvement.
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