Bartus Krzysztof, Sadowski Jerzy, Litwinowicz Radoslaw, Filip Grzegorz, Jasinski Marek, Deja Marek, Kusmierczyk Mariusz, Pawlak Szymon, Jemielity Marek, Jagielak Dariusz, Hendzel Piotr, Suwalski Piotr, Tobota Zdzisław, Maruszewski Bohdan, Kapelak Boguslaw
Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.
Department of Cardiac Surgery, University Hospital in Wroclaw, Wroclaw Medical University, Wroclaw, Poland.
J Thorac Dis. 2019 Jun;11(6):2340-2349. doi: 10.21037/jtd.2019.06.04.
Aortic valve replacement (AVR) is one of the most common surgeries performed in cardiac surgery operating rooms. We present actual, real life trends from the last 10 years for AVR interventions based on a multicentre National Registry of Cardiac Surgery Database.
The study population consisted of all 50,846 consecutive adult patients who underwent AVR between January 2006 and August 2016 in all cardiac surgery units in Poland. The main outcome measures were changes in the number of valves, characteristics of valves, operative details, and in-hospital mortality. Analysis consisted of all aortic valve (AV) procedures, including isolated AV surgery, combination procedures and patients who had a prior valve operation.
In last 10 years, the number of procedures increased by 46%. Isolated surgical AVR was performed in 61.2%, AVR + coronary artery bypass grafting (CABG) in 23.9%, AVR + mitral valve replacement (MVR) in 7%, and transcatheter aortic valve implantation (TAVI) in 2.3% of patients. The mean patient age increased significantly from 61.4 years in 2006 to 66.1 years in 2016. Aortic stenosis was diagnosed in 73.4%, severe aortic insufficiency in 15.8% of cases. The most common valve pathology was calcification. Congenital valve dysfunction was diagnosed in 3.7% of cases. There was a 33.7% increase of bioprosthesis, and the most common implanted bioprosthesis was the Hancock II. The most common implanted mechanical prosthesis was the St. Jude Medical Mechanical Valve. In-hospital mortality decreased significantly over the 10-year period in all AV procedures from 10.9% in 2006 to 8.3% in 2016. Mean in-hospital mortality was: 4.0% in isolated surgical AVR, 5.4% in TAVI, 6.8% in AVR + CABG, 9.8% in AVR + MVR, 17.2% in AVR + MVR + CABG.
In the last ten years, the number of AV procedure has doubled. Mortality was significantly lower with all types of AV procedure despite very rapid aging of AVR patients. TAVI procedure rapidly grew in popularity. There is significant increase in the use of bioprosthesis.
主动脉瓣置换术（AVR）是心脏外科手术室中最常见的手术之一。我们基于多中心国家心脏外科注册数据库，呈现过去10年AVR干预的实际、真实趋势。
研究人群包括2006年1月至2016年8月期间在波兰所有心脏外科单位连续接受AVR的50846例成年患者。主要结局指标为瓣膜数量变化、瓣膜特征、手术细节和住院死亡率。分析包括所有主动脉瓣（AV）手术，包括单纯AV手术、联合手术以及曾接受过瓣膜手术的患者。
在过去10年中，手术数量增加了46%。61.2%的患者接受了单纯外科AVR，23.9%的患者接受了AVR + 冠状动脉旁路移植术（CABG），7%的患者接受了AVR + 二尖瓣置换术（MVR），2.3%的患者接受了经导管主动脉瓣植入术（TAVI）。患者平均年龄从2006年的61.4岁显著增加到2016年的66.1岁。73.4%的病例诊断为主动脉瓣狭窄，15.8%的病例诊断为重度主动脉瓣关闭不全。最常见的瓣膜病变是钙化。3.7%的病例诊断为先天性瓣膜功能障碍。生物瓣膜的使用增加了33.7%，最常用的植入生物瓣膜是Hancock II。最常用的植入机械瓣膜是圣犹达医疗机械瓣膜。在所有AV手术中，10年期间住院死亡率显著下降，从2006年的10.9%降至2016年的8.3%。平均住院死亡率为：单纯外科AVR为4.0%，TAVI为5.4%，AVR + CABG为6.8%，AVR + MVR为9.8%，AVR + MVR + CABG为17.2%。
在过去十年中，AV手术数量翻了一番。尽管AVR患者老龄化非常迅速，但所有类型的AV手术死亡率均显著降低。TAVI手术迅速普及。生物瓣膜的使用显著增加。
