加州经导管主动脉瓣置换术的实施：对主动脉瓣手术的影响。

Implementation of transcatheter aortic valve replacement in California: Influence on aortic valve surgery.

机构信息

Division of Cardiothoracic Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, Calif.

出版信息

J Thorac Cardiovasc Surg. 2018 Apr;155(4):1447-1456. doi: 10.1016/j.jtcvs.2017.07.092. Epub 2018 Jan 4.

DOI:10.1016/j.jtcvs.2017.07.092

PMID:29554785

Abstract

OBJECTIVE

Transcatheter aortic valve replacement (TAVR) procedures were introduced in 2011. Initially, procedures were limited to patients who were not surgical candidates, but subsequently high-risk surgical candidates were considered for TAVR. The influence on aortic valve surgery in California is unknown.

METHODS

The California Office of Statewide Health Planning and Development hospitalized patient discharge database was queried for the years 2009 through 2014. isolated surgical aortic valve and aortic valve/coronary artery bypass graft (SAVR) and TAVR procedures were identified by International Classification of Diseases-9th revision clinical modification procedure codes. Seven TAVR programs were introduced in 2011, 12 in 2012, 3 in 2013, and 6 in 2014. SAVR procedure volumes were compared from the 2 years before institution with SAVR volumes during the year(s) after institution of the TAVR program in these 28 hospitals.

RESULTS

Overall, surgical volumes increased during the first, second, and third years after implementation of TAVR procedures. Among 7 hospitals with 4-year programs, surgical volumes increased to a maximum of 15.5% during the third year, then began to decrease. The hospital performing the largest number of TAVR procedures showed a marked decrease in SAVR volume by the fourth year, suggesting a shift of SAVR candidates to TAVR. Among all hospitals with 4-year programs, TAVR exceeded SAVR procedures by the fourth year. In California overall, SAVR increased during 2011 through 2013, due primarily to increasing volume of isolated SAVR procedures. Statewide, isolated SAVR increased from a yearly average of 3111 procedures during 2009-2010 to 3592 (+15.5%) in 2013, then decreased slightly in 2014. SAVR plus coronary artery bypass graft procedures decreased during the same time period.

CONCLUSIONS

After implementation of TAVR, hospital SAVR volumes increased moderately, then began to decrease by the fourth year, when TAVR volume exceeded SAVR. Surgical candidates may be identified during evaluation for TAVR, resulting in increased SAVR volume. Increasing SAVR volume may also be related to improved patient and provider awareness of aortic valve disease.

摘要

目的

经导管主动脉瓣置换术（TAVR）于 2011 年引入。最初，该手术仅限于不符合手术条件的患者，但随后高危手术患者也被考虑进行 TAVR。加利福尼亚州的主动脉瓣手术受到了何种影响尚不清楚。

方法

通过加利福尼亚州全州卫生规划和发展办公室住院患者出院数据库，对 2009 年至 2014 年期间的孤立性主动脉瓣手术和主动脉瓣/冠状动脉旁路移植术（SAVR）及 TAVR 手术进行了查询。通过国际疾病分类第 9 版临床修正手术代码，确定了 TAVR 程序。2011 年引入了 7 个 TAVR 项目，2012 年引入了 12 个，2013 年引入了 3 个，2014 年引入了 6 个。在这 28 家医院中，比较了 SAVR 项目实施前 2 年和实施后的当年或当年 SAVR 手术量。

结果

总体而言，在 TAVR 手术实施后的第一年、第二年和第三年，手术量均有所增加。在 7 家有 4 年项目的医院中，手术量在第三年达到最高的 15.5%，然后开始下降。开展 TAVR 例数最多的医院，第四年 SAVR 量明显减少，表明 SAVR 患者转向 TAVR。在所有有 4 年项目的医院中，TAVR 在第四年超过了 SAVR 手术。在加利福尼亚州，由于孤立性 SAVR 手术量的增加，SAVR 在 2011 年至 2013 年期间有所增加。全州范围内，孤立性 SAVR 在 2009-2010 年期间的年平均手术量为 3111 例，到 2013 年增加到 3592 例（增加 15.5%），然后在 2014 年略有下降。同期 SAVR 加冠状动脉旁路移植术的数量减少。