Differences in Heart Valve Procedures between North American and European Centers: Report from the Artificial Valve Endocarditis Reduction Trial (AVERT)
Lars Englberger MD, Thierry Carrel MD, Hartzell V. Schaff MD, Elizabeth D. Kennard MD Richard Holubkov MD, for the AVERT Investigators

Differences were evaluated in heart valve procedures between North American (NA) and European (EU) centers in a multicenter trial (AVERT). In 807 patients from 12 NA (n = 446) and seven EU centers (n = 361), subanalysis was performed to compare between-center demographics, patient risk profile, surgical techniques and perioperative patient management. Mean age was significantly younger and body mass index higher in NA centers. Patients ’ risk profiles showed significantly higher incidence of previous myocardial infarction, congestive heart failure, angina, prior cardiovascular surgery, and history of smoking in NA. Concomitant coronary artery bypass grafting was performed in 31.6% of NA patients and 19.4% of EU patients (p <0.001). Timing of surgery showed a higher incidence of urgent procedures in NA centers, but length of hospital stay was longer in EU centers. Surprisingly, surgeons in NA and EU centers are faced by different patient populations requiring heart valve surgery. NA patients were younger but required more extensive surgery. Surgical technique and perioperative management appear to different in NA and EU centers.