Evidence-based Awards for Cardiac Care
Blue Shield of California has designated Stanford Hospital & Clinics as a Blue Distinction Center for Cardiac Care, a distinction by BlueCross and BlueShield companies signifying that our hospital has demonstrated our commitment to quality care, resulting in better overall outcomes for cardiac patients. Stanford Hospital & Clinics meets evidence-based clinical criteria, developed by the Blue Cross Blue Shield Association in collaboration with expert physicians’ and medical organizations, including the American College of Cardiology and the Society of Thoracic Surgeons, and is subject to periodic re-evaluation as criteria continue to evolve.
Additionally, the Society of Thoracic Surgeons (STS) has recently developed a comprehensive rating system for Aortic Valve Replacement surgical procedures that allows for comparisons 
regarding the quality of isolated aortic valve surgery among hospitals across the country. Only 3.2% of U.S. hospitals received the “3 star” rating, which denotes the highest category of quality. In the current analysis of national data covering the period from January 1, 2011 through December 31, 2011 the cardiac surgery performance of Stanford Hospital and Clinics was found to lie in this highest quality tier, thereby receiving an STS “3 star” rating.
United Healthcare has also awarded Stanford Medical Center with the UnitedHealth Premium Cardiac Specialty Center “Three Stars” and “Higher Efficiency” designations, signifying that our facilities offer quantifiable quality and cost-effective cardiac procedures and cardiac care services. Participation in this program is voluntary, and to be considered for this designation, hospitals must complete a survey and submit outcomes data to the American College of Cardiology and/or the Society of Thoracic Surgeons. Surveys are evaluated on an ongoing basis, and the current designation period began in September 2007 and runs through September 2009.
Stanford Hospital’s North Intensive Care Unit (NICU) received the Beacon Award for Critical Care excellence from the American Association of Critical Care Nurses (AACN). This prestigious award is given in recognition of the top intensive care units in the United States and recognizes adult critical care, adult progressive care, and pediatric critical care units that achieve high quality outcomes. The Stanford Hospital NICU staff worked diligently to meet the specific Beacon Award ICU excellence criteria while providing the highest quality of care to their patients and their families.
For the third year in a row, and the fourth time since the creation of Leapfrog Group’s annual class of top hospitals, Stanford Hospital & Clinics has been named as a top U.S. hospital. For Heart Bypass Surgery, Stanford's Quality of Care ranking is "Fully Meets Standards," the highest rank available. This selection is based on the results of the Leapfrog Group's national survey that measures 
hospitals' performance in crucial areas of patient safety and quality. The results are posted on their website and are open to patients and families, the public andemployers, and other purchasers of health care. Leapfrog Group's rating and website offer one of the most complete pictures of a hospital's quality and safety.
View the Reports
The reports presented below compare the outcomes of various procedures performed at Stanford Hospital & Clinics (SHC) to that of the national averages as reported by the STS. Unless noted otherwise, this data is risk adjusted, meaning it takes into account a specific hospital’s and national patient’s preoperative risk factors and co-morbidities and then compares outcomes between the hospital’s and the national average performance. This risk-adjustment method levels the playing field for a valid comparison between hospitals regardless of the severity of the patients they treat.
- Coronary Artery Bypass Graft, Valve, and Valve+CABG Procedures Combined Risk-Adjusted Operative Mortality Rate %
- Isolated Coronary Artery Bypass Graft Risk-Adjusted Operative Mortality Rate %
- Isolated Coronary Artery Bypass Graft & Isolated Aortic Valve Repair Adverse Outcome - Permanent Stroke % (Non-Risk Adjusted)
- Isolated Aortic Valve Replacement Risk-Adjusted Operative Mortality Rate %
- Combined Isolated Mitral Valve Replacement and Mitral Valve Repair Observed Operative Mortality Rate % (Non-Risk Adjusted)
- Aortic Root Surgery: Composite Valve Graft Aortic Valve and Root Replacement & Tirone David Aortic Valve-Sparing Root Replacement Case Volumes
Coronary Artery Bypass Graft (CABG), Valve, and Valve+CABG Procedures Combined
Risk-Adjusted Operative Mortality Rate (RAMR) %
(click image for larger version)
This report reflects the 30-day mortality rate for this group of the most commonly performed cardiac procedures for the average national patient coming to Stanford Hospitals & Clinics (SHC) for an operation. Patients coming to Stanford Hospital & Clinics consistently have a decreased chance of mortality as compared to the average national hospital.
Isolated Coronary Artery Bypass Graft (CABG)
Risk-Adjusted Operative Mortality Rate (RAMR) %
(click image for larger version)
"Isolated Coronary Artery Bypass Graft" means that no other operative procedures were performed other than a coronary artery bypass graft. Again, Stanford Hospital & Clinics (SHC) has consistently better 30-day mortality outcomes than the average national hospital.
Isolated Coronary Artery Bypass Graft (CABG)
& Isolated Aortic Valve Repair (AVR)
Adverse Outcome - Permanent Stroke
%
(Non-Risk Adjusted)
(click image for larger version)
Stroke or cerebral vascular accident (CVA) is a known but rarely occurring complication of cardiac surgery that can be devastating to the patient. Stanford surgeons make every effort to prevent this adverse outcome during all stages of the surgical procedure and postoperative recovery. The experience and techniques used by the Stanford surgical team has consistently kept Stanford’s cardiac surgery stroke complication rate to a minimum.
Isolated Aortic Valve Replacement
Risk-Adjusted Operative Mortality Rate (RAMR) %
(click image for larger version)
This isolated aortic valve replacement 30-day mortality outcomes data includes replacement with both mechanical and bioprosthetic valves where no other procedure is performed. Surgeons at Stanford Hospital & Clinics (SHC) will discuss with each patient the pros and cons of each valve type in relation to their individual aortic valve pathology. The patient is part of the decision-making process in choosing the replacement valve that will provide the best outcomes as well as suit their lifestyles. Transcatheter Aortic Valve Implantation (TAVI) is now available for the high risk patient previously determined not a surgical candidate in collaboration with interventional cardiology.
In November 2008, Stanford University Medical Center (one of four selected West Coast medical centers) began participation in the investigative PARTNER (Placement of Aortic Transcatheter Valves) U.S. pivotal trial directed at patients with severe symptomatic aortic stenosis considered high operative risk due to age, co-morbid conditions or previously deemed inoperable. Nearly 50% of Sanford’s 2009 aortic valve replacement (AVR) patients were greater than 80 years of age and the Society of Thoracic Surgeons (STS) predicted risk of mortality for Stanford’s AVR patient group was 2½ times greater than the STS national average. Stanford’s 2009 AVR risk adjusted mortality rate (RAMR) increased over the historically low rates as standard and investigational PARTNER AVR procedures were performed on an extremely high risk patient group. The experience gained in 2009 has led to a 2010 risk adjusted mortality rate nearly half that of the STS national rate while treating a significantly higher risk, more complex patient population.
Stanford’s goal is to comprehensively evaluate a patient’s suitability for all types of aortic valve interventions to provide the most effective treatment options with the goal to improve and prolong quality and duration of life.
More information about the PARTNER trial:
- (article) New treatment for severe aortic stenosis shown to save lives, researchers say
- (video) PARTNER Trial Treatment for Severe Aortic Stenosis
Combined Isolated Mitral Valve Replacement and Mitral Valve Repair Observed Operative Mortality Rate % (Non-Risk Adjusted)
(click image for larger version)
This is actual (observed) 30-day mortality rate comparison for a combination of the two types of mitral valve procedures: mitral valve repair and mitral valve replacement. Mitral valve repair is associated with better patient outcomes, and Stanford will repair the mitral valve unless replacement is absolutely necessary. In 2010, 68% of Stanford’s isolated mitral valve procedures were repairs compared to 57% nationally. Stanford has dedicated research laboratories continually evaluating the best methods and equipment for mitral valve surgery.
Aortic Root Surgery:
Composite Valve Graft (CVG) Aortic Valve and Root Replacement & Tirone David Aortic Valve-Sparing Root Replacement Case Volumes
(click image for larger version)
A Tirone David V with Stanford modification valve-sparing aortic root replacement (VSARR) operation utilizes the native aortic valve so the patient doesn't need life-long anti-coagulation therapy. This is a great benefit to patients with Marfan Syndrome or a bicuspid aortic valve, particularly the young and middle-aged. A composite valve graft (CVG) procedure combines either a mechanical or bioprosthetic valve built into the replacement section of the aortic root, usually combined with an ascending aorta replacement graft. Stanford's surgeons thoroughly evaluate each individual patient's pathology and lifestyle and allow each individual to help choose the best surgical procedure for the best long-term outcome. Stanford's thoracic aortic surgical team has performed more Tirone David procedures than any other hospital in the western United States. Stanford University's Center for Marfan Syndrome and Related Aortic Disorders is used as a model around the world.
The actual 30-day operative mortality rate for elective and urgent CVG procedures from 2006 to 2010 is 3.2%. Although there is no Society of Thoracic Surgery (STS) benchmark regarding mortality rates for complex CVG aortic root replacement procedures, this 3.2% mortality rate can be compared to the 2010 STS national mortality rate for a basic isolated aortic valve replacement (3.0%) to better understand the experience and expertise provided at Stanford for complex heart surgery.
Stanford's long history of performing and improving upon VSARR operations is reflected in our mortality outcomes. In our seventeen-year history of performing this procedure (electively or urgently), the mortality rate is less than 1%, with no 30-day operative mortality within the last six years. A comparison with the 2010 STS national mortality rate of 3.0% for basic isolated aortic valve replacement highlights our ability to perform complex aortic procedures with lower risk than other centers that perform less complex procedures.
