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This report shows the risk adjusted 30-day mortality rate (RAMR) for the most commonly performed cardiac procedures in the United States. Patients coming to Stanford Health Care consistently have a decreased chance of mortality as compared to the average national hospital.

Isolated Coronary Artery Bypass Graft (IsoCABG) means that no other operative procedures were performed along with the coronary artery bypass grafts. Again, Stanford Health Care (SHC) has consistently better 30-day risk adjusted mortality outcomes than the average national hospital. SHC surgeons are experienced in performing "off-pump," minimally invasive, and robotic surgery as indicated for the patient's needs to insure the best outcomes and post-operative quality of life.

This risk adjusted isolated aortic valve replacement 30-day mortality (IsoAVR RAMR) report includes replacement with both mechanical and bioprosthetic valves where no other procedure is performed. Surgeons at Stanford Health Care (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. Stanford is one of the most experienced minimally invasive Transcatheter Aortic Valve Replacement (TAVR) programs on the west coast. TAVR is now approved for a larger diverse group of patients in addition to the high-risk patient previously determined not a surgical candidate. Stanford cardiac surgeons in collaboration with Interventional Cardiology discuss all available surgical options with our patients to determine the best individual treatment plan.

The Society of Thoracic Surgeons (STS) has 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 12-15% of hospitals in the US received the "3 Star" rating, which denotes the highest category of quality. In the analysis of national data covering the period from January 2011 through December 2016 the cardiac surgery performance of Stanford Health Care was found to lie in this highest quality tier, thereby receiving an STS "3 Star" rating.

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.

Stanford Health Care has performed over 1,000 minimally invasive transcatheter aortic valve replacement (TAVR) procedures since the onset of the Centers for Medicare & Medicaid Services-sponsored PARTNER Clinical Trials. As the clinical success of TAVR has been demonstrated over time, more patients than ever can be evaluated and approved for entry into the TAVR program.

More information about the PARTNER trial:

• (website) Stanford TAVR Program
• (fact scheet) Stanford Transcatheter Heart Valve Program
• (article) New treatment for severe aortic stenosis shown to save lives, researchers say
• (video) PARTNER Trial Treatment for Severe Aortic Stenosis

Mitral valve disease is a serious condition often requiring surgical valve replacement or repair. Mitral valve repair is associated with better patient outcomes, and Stanford surgeons will repair the mitral valve unless replacement is absolutely necessary. Stanford has dedicated research laboratories continually evaluating the best surgical techniques and equipment for mitral valve surgery.

The Society of Thoracic Surgeons (STS) has developed a comprehensive rating system for Mitral Valve Repair & Replacement surgical procedures that allows for comparisons regarding the quality of isolated mitral valve surgery (IsoMV Repair) among hospitals across the country. Only 12-15% of hospitals in the US received the STS "3 Star" rating, which denotes the highest category of quality. In the current analysis of national data covering the period from July 2015 through June 2018, the cardiac surgery performance of Stanford Health Care (SHC) was found to lie in this highest quality tier, thereby receiving an STS "3 Star" rating.

SHC surgeons are experienced in performing minimally invasive mitral valve procedures when indicated for best patient outcomes. Transcatheter Mitral Valve Replacement surgery (TMVR) and Mitral Valve Repair surgery (MitraClip) are available for the high-risk patient previously determined not a surgical candidate in collaboration with interventional cardiology.

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.

Stanford's long history of performing and improving upon VSARR operations is reflected in our mortality outcomes. In our twenty-five 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 fourteen years. A comparison with the 2017 STS risk adjusted national mortality rate of 2.0% for basic isolated aortic valve replacement highlights Stanford surgeons’ ability to perform complex aortic procedures with lower risk than hospitals that perform less complex cardiac procedures.