Surgery for aortic and mitral valve disease in the United States: A trend of change in surgical practice between 1998 and 2005

Objective: The surgical treatment of valvular heart disease has changed significantly in the past decade with more mitral valves being repaired and tissue valves implanted in the aortic position. The National Inpatient Sample was used to document national trends of primary isolated aortic and mitral valve surgical procedures. Methods: Subjects were adult patients who had an isolated aortic or mitral valve repair or replacement in the United States. Estimated institution cost and total billed charges data were provided by the Centers for Medicare and Medicaid Services. Results: From 1998 to 2005, an estimated 330,000 aortic or mitral valve procedures were performed in the United States (repair, n - 46,342; replacement, n - 287,989). Since 1998, annual valve repair or replacement procedures increased 186.6% and 12.6%, respectively. Aortic valve repair or replacement procedures increased 102.5% and 28.0%, respectively, with an increased percentage for repairs from 2.0% in 1998 to 3.1% in 2005. Mitral valve repair procedures increased from 18.9% in 1998 to 45.8% in 2005, with mitral replacements decreasing 17.2% over the same period. Since 1998, the total hospital billed charges for aortic valve repair procedures increased 80.6% and aortic valve replacement procedures 90.4%; mitral valve repair procedures increased from 37.8%, replacement 42.0%. Annual increases in estimated institution cost increased for both aortic and mitral procedures on average 8% to 9%. Conclusion: During the last decade the practice of valve surgery has changed significantly. The surgical treatment for mitral disease has transitioned to primarily one of repair, not replacement, with the use of bioprostheses more than doubled. For the aortic position, the primary procedure remained valve replacement with bioprosthesis being the valve of choice. Regardless of valve disease, institutional costs and charges for the surgical treatment have greatly outpaced physician reimbursement.