Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Division of Cardiovascular Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Cardiology Division, Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts.
JACC Cardiovasc Interv. 2018 Nov 12;11(21):2148-2156. doi: 10.1016/j.jcin.2018.07.002. Epub 2018 Oct 17.
This study sought to evaluate the trends in isolated surgical aortic valve replacement (SAVR) procedures across hospitals with different transcatheter aortic valve replacement (TAVR) volumes among Medicare beneficiaries.
The volume of TAVR has increased in the United States since its approval, now exceeding that of isolated SAVR.
Hospitalizations of adults (≥18 years of age) with International Classification of Diseases-9th Revision-Clinical Modification procedure codes for SAVR (35.21 or 35.22) or TAVR (35.05 or 35.06) who were included in the Medicare Provider Analysis and Review database between January 1, 2011, and December 31, 2014, were included. Trends in isolated SAVR patient characteristics, procedural volumes, and outcomes by quartile (Q) of hospital-level TAVR use were assessed over the study period.
A total of 37,705 isolated SAVR procedures were analyzed for the study. The annual volume of isolated SAVR procedures decreased in hospitals performing the largest number of TAVR procedures (Q3: 1,557 in 2011 to 1,391 in 2014; and Q4: 2,607 in 2011 to 1,791 in 2014). Thirty-day and 1-year mortality after SAVR also declined over the study period in hospitals with the largest TAVR volume (annual change rate in mortality for Q3: -16.4%; p < 0.001; Q4: -20.8%; p < 0.001).
The advent of TAVR was associated with a reduction in isolated SAVR volumes, a decrease in comorbidities among patients undergoing SAVR, and corresponding reductions in observed short- and long-term SAVR mortality among hospitals performing the greatest number of TAVRs.
本研究旨在评估在接受医疗保险的患者中，不同经导管主动脉瓣置换术（TAVR）量的医院之间，孤立性主动脉瓣置换术（SAVR）手术的趋势。
自批准以来，美国的 TAVR 量不断增加，现已超过孤立性 SAVR。
纳入了 Medicare Provider Analysis and Review 数据库中 2011 年 1 月 1 日至 2014 年 12 月 31 日期间，接受国际疾病分类第 9 版临床修正程序代码 35.21 或 35.22 用于 SAVR 或 35.05 或 35.06 用于 TAVR 的成年人（≥18 岁）的住院患者。评估了研究期间按医院 TAVR 使用量四分位数（Q）的孤立性 SAVR 患者特征、手术量和结果趋势。
本研究共分析了 37705 例孤立性 SAVR 手术。在 TAVR 手术量最大的医院，孤立性 SAVR 手术的年手术量减少（Q3：2011 年为 1557 例，2014 年为 1391 例；Q4：2011 年为 2607 例，2014 年为 1791 例）。在 TAVR 量最大的医院，SAVR 术后 30 天和 1 年的死亡率也在研究期间下降（Q3：死亡率年变化率为-16.4%；p<0.001；Q4：-20.8%；p<0.001）。
TAVR 的出现与孤立性 SAVR 量减少、接受 SAVR 治疗的患者合并症减少以及接受 TAVR 治疗的医院观察到的短期和长期 SAVR 死亡率相应降低有关。
