Division of Cardiology, Federal University of Sergipe, and the Clínica e Hospital São Lucas, Aracaju, Sergipe, Brazil10Center for Outcomes Research and Evaluation at Yale-New Haven Hospital (during the time that the work was conducted).
JAMA. 2013 Nov 20;310(19):2078-85. doi: 10.1001/jama.2013.282437.
There is a need to describe contemporary outcomes of surgical aortic valve replacement (AVR) as the population ages and transcatheter options emerge.
To assess procedure rates and outcomes of surgical AVR over time.
DESIGN, SETTING, AND PARTICIPANTS: A serial cross-sectional cohort study of 82,755,924 Medicare fee-for-service beneficiaries undergoing AVR in the United States between 1999 and 2011.
Procedure rates for surgical AVR alone and with coronary artery bypass graft (CABG) surgery, 30-day and 1-year mortality, and 30-day readmission rates.
The AVR procedure rate increased by 19 (95% CI, 19-20) procedures per 100,000 person-years over the 12-year period (P<.001), with an age-, sex-, and race-adjusted rate increase of 1.6% (95% CI, 1.0%-1.8%) per year. Mortality decreased at 30 days (absolute decrease, 3.4%; 95% CI, 3.0%-3.8%; adjusted annual decrease, 4.1%; 95% CI, 3.7%- 4.4%) per year and at 1 year (absolute decrease, 2.6%; 95% CI, 2.1%-3.2%; adjusted annual decrease, 2.5%; 95% CI, 2.3%-2.8%). Thirty-day all-cause readmission also decreased by 1.1% (95% CI, 0.9%-1.3%) per year. Aortic valve replacement with CABG surgery decreased, women and black patients had lower procedure and higher mortality rates, and mechanical prosethetic implants decreased, but 23.9% of patients 85 years and older continued to receive a mechanical prosthesis in 2011.
Between 1999 and 2011, the rate of surgical AVR for elderly patients in the United States increased and outcomes improved substantially. Medicare data preclude the identification of the causes of the findings and the trends in procedure rates and outcomes cannot be causally linked. Nevertheless, the findings may be a useful benchmark for outcomes with surgical AVR for older patients eligible for surgery considering newer transcatheter treatments.
随着人口老龄化和经导管治疗选择的出现，需要描述手术主动脉瓣置换术（AVR）的当代结果。
随着时间的推移，评估手术 AVR 的程序率和结果。
设计、地点和参与者：这是一项在美国医疗保健费用服务受益人群中进行的 82755924 例手术 AVR 的连续横断面队列研究，时间范围为 1999 年至 2011 年。
单独进行手术 AVR 以及同时进行冠状动脉旁路移植术（CABG）的手术率、30 天和 1 年死亡率以及 30 天再入院率。
在 12 年期间，手术 AVR 程序率增加了 19 例（95%CI，19-20）/每 100000 人年（P<.001），年龄、性别和种族调整后的增长率为每年 1.6%（95%CI，1.0%-1.8%）。30 天死亡率下降（绝对下降 3.4%；95%CI，3.0%-3.8%；调整后的年下降率 4.1%；95%CI，3.7%-4.4%）和 1 年死亡率下降（绝对下降 2.6%；95%CI，2.1%-3.2%；调整后的年下降率 2.5%；95%CI，2.3%-2.8%）。30 天全因再入院率也以每年 1.1%（95%CI，0.9%-1.3%）的速度下降。AVR 与 CABG 手术联合进行的比例下降，女性和黑人患者的手术和死亡率较高，机械假体植入物减少，但 2011 年仍有 23.9%的 85 岁及以上患者接受机械假体。
1999 年至 2011 年间，美国老年患者手术 AVR 的比例增加，结果显著改善。医疗保险数据无法确定这些发现的原因，也无法将手术率和结果的趋势与因果关系联系起来。尽管如此，对于考虑新的经导管治疗方法的符合手术条件的老年患者，这些发现可能是手术 AVR 结果的有用基准。
