Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Thorac Cardiovasc Surg. 2024 Apr;72(3):173-180. doi: 10.1055/s-0042-1754352. Epub 2022 Aug 2.
Literature demonstrated that procedure volumes affect outcomes of patients undergoing transcatheter aortic valve implantation. We evaluated the outcomes of surgical aortic valve replacement.
All isolated surgical aortic valve replacement procedures in Germany in 2017 were identified. Hospitals were divided into five groups from ≤25 (very low volume) until >100 (very high volume) annual procedures.
In 2017, 5,533 patients underwent isolated surgical aortic valve replacement. All groups were of comparable risk (logistic EuroSCORE, 5.12-4.80%) and age (66.6-68.1 years). In-hospital mortality and complication rates were lowest in the very high-volume group. Multivariable logistic regression analyses showed no significant volume-outcome relationship for in-hospital mortality, stroke, postoperative delirium, and mechanical ventilation > 48 hours. Regarding acute kidney injury, patients in the very high-volume group were at lower risk than those in the very low volume group (odds ratio [OR] = 0.53, = 0.04). Risk factors for in-hospital mortality were previous cardiac surgery (OR = 5.75, < 0.001), high-grade renal disease (glomerular filtration rate < 15 mL/min, OR = 5.61, = 0.002), surgery in emergency cases (OR = 2.71, = 0.002), and higher grade heart failure (NYHA [New York Heart Association] III/IV; OR = 1.80, = 0.02). Risk factors for all four complication rates were atrial fibrillation and diabetes mellitus.
Patients treated in very low volume centers (≤25 operations/year) had a similar risk regarding in-hospital mortality and most complications compared with very high-volume centers (>100 operations/year). Only in the case of acute kidney injury, very high-volume centers showed better outcomes than very low volume centers. Therefore, surgical aortic valve replacement can be performed safely independent of case volume.
文献表明，手术量会影响行经导管主动脉瓣植入术患者的预后。我们评估了主动脉瓣置换术的结果。
确定了 2017 年德国所有孤立的主动脉瓣置换术。医院分为五组，每年手术量从≤25（极低量）到>100（极高量）。
2017 年，5533 例患者接受了孤立的主动脉瓣置换术。所有组的风险（逻辑 EuroSCORE，5.12-4.80%）和年龄（66.6-68.1 岁）都相似。极高量组的院内死亡率和并发症发生率最低。多变量逻辑回归分析显示，院内死亡率、卒中、术后谵妄和机械通气>48 小时与手术量之间无显著关系。对于急性肾损伤，高容量组患者的风险低于低容量组（比值比[OR] = 0.53，= 0.04）。院内死亡率的危险因素是既往心脏手术（OR = 5.75，<0.001）、高级别肾功能障碍（肾小球滤过率<15 mL/min，OR = 5.61，= 0.002）、急诊手术（OR = 2.71，= 0.002）和更高级别的心力衰竭（纽约心脏协会[NYHA] III/IV；OR = 1.80，= 0.02）。四种并发症发生率的危险因素是心房颤动和糖尿病。
与高容量中心（>100 例/年）相比，低容量中心（≤25 例/年）的患者在院内死亡率和大多数并发症方面的风险相似。只有在急性肾损伤的情况下，高容量中心的结果才优于低容量中心。因此，主动脉瓣置换术可以在独立于手术量的情况下安全进行。
