Summary of California-wide Trends in Cardiac Procedures - Mortality after Cardiac Surgery / Intervention

Mortality is based on deaths that occurred during the surgery admission or acute care admissions following transfer after the index surgery/intervention that were connected to the index admission and in-hospital / emergency room deaths that occurred after a discharge home and within 30 days of the procedure.

Mortality after Cardiac Procedures, California, 2017-2018

Cardiac ProcedureNumber of ProceduresNumber of Events% Mortality
Isolated CABG 24,243 591 2.44
Isolated SAVR, MVR, MV Repair 9,410 268 2.85
TAVR 9,386 178 1.90
Isolated SAVR, MVR, MV Repair with CABG 4,150 220 5.31
PCI with ACS 56,644 2,925 5.16
PCI without ACS 44,663 703 1.57
CABG: Coronary Artery Bypass Graft
SAVR: Surgical Aortic Valve Replacement
MVR: Mitral Valve Replacement
MV Repair: Mitral Valve Repair
TAVR: Transcatheter Aortic Valve Replacement
PCI: Percutaneous Coronary Intervention
ACS: Acute Coronary Syndrome

Mortality after isolated CABG or isolated Surgical AVR, MVR or MV Repair with or without CABG decreased from 1999 to 2018. For Transcatheter AVRs, after an initially very high level of mortality in 2011, the decrease in mortality is striking and possibly related to a new procedure being refined by California surgeons. Mortality after PCI with or without ACS increased from 1999 to 2018, from 4.0% to 5.4% for PCI with ACS, and from 1% to 1.7% for PCI without ACS.

At the same time, looking at a case mix indicator - the expected mortality rates implied by the model for mortality - the average California heart procedure patient has steadily become sicker for most cardiac procedure groups. This trend is particularly pronounced for patients undergoing PCI with ACS. Decreased mortality after cardiac surgery is therefore unlikely to be a result of procedures being performed on healthier patients, rather management of the cardiac patient has improved. The increased mortality after PCI coupled with increasingly sicker patients undergoing the procedure needs to be explored further.

Using the mortality level in 2017-2018 as a standard, casemix adjusted mortality after isolated CABG surgery, isolated Surgical AVR, MVR or MV Repair with or without CABG, and PCI with ACS decreased significantly from 1999 to 2018. For PCI without ACS, a significant decrease in casemix adjusted mortality occurred from 1999 to 2010, and from then on, mortality has increased back to 2001 levels.