Cardiothoracic Surgery

Cardiothoracic Surgical Outcome Reports

Choosing a qualified hospital can be a daunting task, especially for patients facing major surgery. Hospitals in the state of California are required to collect and submit quality data to help inform patients about the safety and success rate of common procedures in cardiothoracic surgery.

Comparing measures like the number of procedures performed each year, the number of deaths as a result of operations, and the overall risk-adjusted mortality rate of the hospital allow patients considering heart surgery and their physicians to make more informed decisions about which hospital will best meet their needs.

Stanford Hospital’s dedication to exceeding national standards of excellence and the Department of Cardiothoracic Surgery's commitment to patient service has helped achieve impressive results in cardiothoracic surgical outcomes.

3 starsThe Society of Thoracic Surgeons (STS) has recently developed a comprehensive rating system for Aortic Valve Replacement surgical procedures that allows for comparisonsregarding the quality of isolated aortic valve surgery among hospitals across the country. Only 12-15% 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 2010 through December 2013 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.

Additionally, 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.

Detailed Surgical Outcomes Data

The charts below compare the outcomes of various procedures performed at Stanford Hospital & Clinics to that of the national averages as reported by the Society for Thoracic Surgeons, the largest association of cardiovascular and thoracic surgeons in the country. Unless noted otherwise, this data is risk-adjusted, a method that allows hospitals to validly compare outcomes regardless of how severely ill a patient is before surgery. The outcomes listed below represent only some of the most common cardiovascular services offered at Stanford.

Major Procedures

Coronary Artery Bypass Graft (CABG) (Heart Bypass Surgery)

CABG is the most common type of open-heart surgery in the United States, with more than 500,000 surgeries performed each year. During CABG, a healthy artery or vein from another part of the body is connected, or grafted, to the blocked coronary artery. The grafted artery or vein creates a new passage that routes oxygen-rich blood around the blockage to the heart muscle.

Isolated CABG

Isolate Coronary Artery Bypass Graft Risk-Adjusted Operative Mortality Rate Graph
Risk-adjusted operative mortality rate for Isolated CABG
(click image for larger version)

While some heart surgeries combine a number a procedures to repair the heart, an isolated coronary artery bypass graft means that no other procedures were performed during the CABG operation. Again, Stanford Hospital & Clinics has consistently better survival outcomes than the average hospital.

Heart Valve Repair and Replacement

The heart has four valves that open and close with each heartbeat, making sure that blood flows in the right direction through the heart's four chambers and then out to the rest of the body. Heart valve disease is a condition in which one or more of the heart valves don't work properly. Birth defects, age-related changes, infections, or other conditions can cause the heart’s valves to not open fully or to let blood leak back into the heart chambers, making the heart and hindering its ability to pump blood. A damaged heart valve can be repaired or it may need to be replaced.

Mitral Valve Repair and Replacement

Combined Isolated Mitral Valve Replacement and Mitral Valve Repair Observed Operative Mortality Rate (Non-Risk Adjusted)
Observed operative mortality rate for combined isolated mitral valve replacement and mitral valve repair
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The data in this chart is based on the actual, or observed, 30-day mortality rate 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 Hospital & Clinics 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.

Isolated Aortic Valve Replacement

When a heart valve cannot be repaired, it must be replaced. This surgery involves removing the faulty valve and replacing it with a mechanical valve or a bioprosthetic valve. If you are considering valve replacement, ask your physician to discuss the advantages and disadvantages of mechanical and bioprosthetic valves.

Isolated Aortic Valve Replacement Risk-Adjusted Operative Mortality Rate Graph
Risk-adjusted operative mortality rate for isolated aortic valve replacement
(click image for larger version)

This isolated aortic valve replacement outcomes data includes replacement with both mechanical and bioprosthetic valves where no other procedure is performed. Surgeons at Stanford Hospital & Clinics discuss with each patient the pros and cons of each valve type in relation to their individual circumstances. The patient is part of the decision-making process in choosing the replacement valve that will provide the best outcomes and suit their lifestyles.

Aortic Root Surgery

The aortic root attaches the aorta to the heart and includes the aortic valve. A Tirone David procedure is an operation that allows a surgeon to replace the faulty aortic root without replacing the aortic valve so that after surgery the patient does not 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.

If the aortic valve is too damaged and needs to be replaced, surgeons can perform a composite valve graft (CVG) procedure, which replaces the damaged valve with a mechanical or bioprosthetic valve. Stanford surgeons thoroughly evaluate each patient’s circumstances to encourage individuals to choose the best surgical procedure for the best long-term outcome.

Aortic Root Surgery: Composite Valve Graft (CVG) Aortic Valve and Root Replacement & Tirone David Aortic Valve-Sparing Root Replacement Case Volumes Graph
Case volumes for composite valve graft (CVG) aortic valve and root replacement & Tirone David aortic valve-sparing root replacement 
(click image for larger version)

Stanford's thoracic aortic surgical team has performed more Tirone David procedures than any other hospital in the western United States. 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. Stanford University's Center for Marfan Syndrome and Related Aortic Disorders is used as a model around the world.

Combined Heart Bypass and Valve Repair

Risk-Adjusted Operative Mortality Rate Coronary Artery Bypass Graft, Valve, and Valve + CABG Procedures Combined
Risk-adjusted operative mortality rate for Coronary Artery Bypass Graft (CABG), Valve, and Valve + CABG procedures combined
(click image for larger version)

This graph compares the 30-day mortality rate for the type of surgeries most commonly performed on heart surgery patients. The percentage inside the bar graph shows the mortality rate for patients at Stanford Hospital compared to the national average. The lower the percentage, the more likely it is that a patient will receive a successful operation. Stanford Hospital & Clinics consistently performs better than the national average for these most commonly performed surgical procedures.

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