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Guidelines for reporting morbidity and mortality after cardiac valvular operations
L H Edmunds1, R E Clark, L H Cohn
1Dept. of Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
Insights
This review updates definitions for prosthetic heart valve morbidity to improve reporting of cardiac valve surgery outcomes. Standardized definitions help compare results across different patient groups and surgical techniques.
Area of Science:
- Cardiovascular Surgery
- Medical Device Technology
- Clinical Guidelines
Background:
- The Society of Thoracic Surgeons (STS) and American Association of Thoracic Surgery (AATS) initiated a review of 1988 guidelines.
- Cardiac valvular procedures have significantly evolved since the initial guidelines were published.
- Existing guidelines required updates to clarify definitions related to prosthetic heart valve morbidity.
Purpose of the Study:
- To update and clarify definitions for prosthetic heart valve morbidity.
- To establish standardized terminology for reporting outcomes of cardiac valve operations.
- To facilitate comparative analysis of different surgical techniques and patient cohorts.
Main Methods:
- Review of existing "Guidelines" on prosthetic heart valve morbidity.
- Consideration of recommendations from other relevant bodies.
- Development of updated definitions for "operated valve" encompassing various valve types and procedures.
Main Results:
- The term "operated valve" now includes prosthetic, bioprosthetic, repaired native, allograft, and autograft valves.
- Acknowledged that patient variables significantly influence outcomes, alongside operated valve factors.
- Emphasized that guidelines facilitate analysis but do not preclude detailed patient-specific investigations.
Conclusions:
- The updated definitions and reporting suggestions aim to standardize the analysis of cardiac valve surgery results.
- These guidelines serve to facilitate comparisons between different surgeons, patient cohorts, and techniques.
- Investigators are encouraged to report both operated valve factors and relevant patient variables for comprehensive outcome assessment.
Abstract:
At the request of the Councils of the Society of Thoracic Surgeons (STS) and the American Association of Thoracic Surgery (AATS) the Ad Hoc Liaison Committee for Standardizing Definitions of Prosthetic Heart Valve Morbidity reviewed the "Guidelines" published in September 1988 [3, 7, 8]. The purpose of the review was to update and clarify definitions within the guidelines and to consider recommendations made by other [2, 11]. The variety of cardiac valvular procedures has expanded since 1988; therefore, in this document the term "operated valve" indicates prosthetic and bioprosthetic heart valves of all types, operated or repaired native valves and allograft and autograft valves. The term "operated valve" includes any cardiac valve altered by a surgeon during an operation. Much morbidity and mortality is a direct consequence of the interaction between the patient and operated valve(s), although patient variables (e.g., age, degree of coronary arterial disease, follow-up care, etc.) may be more responsible for outcomes than an operated valve. However, no set of guidelines can identify all possible patient factors that may affect morbidity and mortality. General agreement regarding the following definitions of terms and suggestions for reporting data do not preclude more detailed analyses or constructive recommendations and investigators are encouraged to identify relevant patient factors in addition to factors related to operated valves. Purpose The purpose of these guidelines is to facilitate the analysis and reporting of results of operations on diseased cardiac valves. The definitions and recommendations that follow are guidelines, not standards, and are designed to facilitate comparisons between the experiences of different surgeons who treat different cohorts of patients at different times with different techniques and materials.