Du Dongyi Tony, Lu Xiaoxiao, McKean Stephen, Warnock Rob, Laschinger John, Loyo-Berríos Nilsa, Marinac-Dabic Danica
Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Md.
Office of Surveillance and Biometrics, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, Md.
J Thorac Cardiovasc Surg. 2020 Jan;159(1):62-69. doi: 10.1016/j.jtcvs.2019.02.012. Epub 2019 Feb 26.
Both biological and mechanical prosthetic valves are treatment choices for aortic valve replacement. We aimed to characterize the selection of prosthetic aortic valves among elderly Medicare patients.
This was a retrospective analysis of patients aged 65 years or older who underwent aortic valve replacement alone or in combination with other procedures in the 2006-2015 Medicare databases. Patients were continuously enrolled in Medicare Part A and B. We characterized the trends and regional variation of the selection of prosthetic valves. Multivariable logistic regression was used to evaluate the determinants that influenced the selection of prosthetic valves.
During the study period, there were 272,921 Medicare patients aged 65 years or older who underwent aortic valve replacement and met the inclusion and exclusion criteria. The selection of mechanical aortic valves decreased from 32.0% in 2006 to 24.3% in 2015 (P < .01). In comparison with 18.5% from northeastern states, 34.6% of patients from southern states selected mechanical valves (P < .01). Major determinants of the selection of prosthetic valves include age, gender, region, hospital characteristics, and physician experience. Patients being older, male, living in the northeast region, operated on in a high-volume hospital, and by more experienced physicians were more likely to receive biological valves.
A 24.1% decrease in the selection of mechanical aortic valves was observed among elderly Medicare patients from 2006 to 2015. A dramatic regional difference was observed in the choice of prosthetic valves across the nation.
生物人工心脏瓣膜和机械人工心脏瓣膜都是主动脉瓣置换术的治疗选择。我们旨在描述老年医疗保险患者中人工主动脉瓣膜的选择特征。
这是一项对2006 - 2015年医疗保险数据库中年龄在65岁及以上、单独接受主动脉瓣置换术或与其他手术联合进行主动脉瓣置换术的患者的回顾性分析。患者持续参加医疗保险A部分和B部分。我们描述了人工瓣膜选择的趋势和地区差异。采用多变量逻辑回归评估影响人工瓣膜选择的决定因素。
在研究期间，有272,921名年龄在65岁及以上的医疗保险患者接受了主动脉瓣置换术并符合纳入和排除标准。机械主动脉瓣膜的选择比例从2006年的32.0%降至2015年的24.3%（P <.01）。与东北部各州18.5%的患者相比，南部各州34.6%的患者选择了机械瓣膜（P <.01）。人工瓣膜选择的主要决定因素包括年龄、性别、地区、医院特征和医生经验。年龄较大、男性、居住在东北地区、在大容量医院接受手术以及由经验更丰富的医生进行手术的患者更有可能接受生物瓣膜。
2006年至2015年期间，老年医疗保险患者中机械主动脉瓣膜的选择比例下降了24.1%。在全国范围内，人工瓣膜的选择存在显著的地区差异。
