Ghosh Probal
Department of Cardiac Surgery, St. John's Hospital, Salzburg, Austria.
J Heart Valve Dis. 2004 Jan;13(1):1-10; discussion 10.
This study sought to elaborate the changing trends in valve surgery in Europe during the 1990s.
The databases of different national surgical societies, registries and governments and international organizations were consulted and the data obtained were analyzed.
The population of Europe (excluding Russia, CIS and Turkey) increased by 2.29%, from 509.67 million in 1991 to 519.15 million in 2000. During this period, the volume of cardiac surgery increased in Europe by 101% to 413,520 operations (797 per 10(6) population). The volume of valve surgery increased by 63% to 85,076 (164 per 10(6) population). The largest volumes of valve surgery were performed in Germany, France, UK, Italy and Spain. The increase in valve surgery volume was maximum in the Baltic states (+287%) and least in Scandinavia (+30%). Valve surgery volume per center per year changed from 139 in 1991 to 140 in 2000. The increase in overall valve surgery volume was sustained by an increase in subsets of octogenarian patients, valve surgery combined with coronary artery surgery, and increased productivity of the emerging economies of countries such as the Czech Republic, Hungary and Poland. Valve surgery as a proportion of cardiac surgery in Europe changed from 25.95% in 1991 to 21% in 2000. In 2000, valve surgery with combined procedures constituted 6.7% of total cardiac surgical volume, but 32% of valve surgical output in Europe. Mechanical valves have continued to dominate and were used in 77% of cases in 2000. Increased use of bioprostheses in the elderly subset among affluent economies was balanced by an increased use of mechanical prostheses in younger patients in emerging facilities in the East and South. The capital-intensive innovations (viz. robotic valve surgery, minimally invasive valve surgery, bioengineered valves) found niches only in some West European centers. Catheter-based procedures did not fulfil their promise. Balloon aortic valve dilatation investigations decreased drastically by the end of the decade, and balloon mitral dilatations number. Conservative aortic valve surgery is not yet practiced widely across Europe, while mitral repair has become widely accepted in clinical parlance.
Despite the greater political and economic integration of Europe, the pattern of valve surgery continues to remain extremely diverse within the continent.
