General and Interventional Cardiology/Angiology, Heart and Diabetes Centre Nord Rhine-Westphalia, University Hospital of the Ruhr University Bochum, Bad Oeynhausen, Germany.
Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK.
Cardiology. 2023;148(6):547-555. doi: 10.1159/000533633. Epub 2023 Aug 16.
The management of patients with severe aortic stenosis may differ according to patients' age. The aim of this analysis was to describe patterns of aortic valve replacement (AVR) use in European countries stratified by age.
Procedure volume data for AVR, including surgical aortic valve replacement (sAVR) and transcatheter aortic valve implantation (TAVI), for the years 2015-2020 were obtained from national databases for twelve European countries (Austria, the Czech Republic, Denmark, England, Finland, France, Germany, Norway, Poland, Spain, Sweden, and Switzerland). Procedure volumes were reported by patient age (<50 years, 5-year age groups between 50 and 85 years, and ≥85 years). Patients per million (PPM) population undergoing AVR each year were calculated using population estimates from Eurostat.
AVR PPM varied widely between countries, from 508 PPM in Germany to 174 PPM in Poland in 2020. TAVI rates ranged from 61% in Switzerland and Finland to 25% in Poland. AVR PPM increased with age to a peak at 80-84 years, after which it decreased again. AVR procedures increased from 2015 to 2019 at an average annual rate of 3.9%. AVR increased more substantially in people aged ≥80 years than in younger age groups; these older age groups accounted for 30% of all AVR procedures in 2015 and 35% in 2019. TAVI accounted for an increasing proportion of all AVR procedures as patient age increased; an overall average of 96% of males and 98% of females aged ≥85 years received TAVI as the treatment modality, although adoption of TAVI differed between countries.
There is considerable variation in the rates of AVR use and the adoption of TAVI versus sAVR between European countries. The use of TAVI has increased in recent years, particularly for older patients.
主动脉瓣重度狭窄患者的管理可能因年龄而异。本分析旨在描述按年龄分层的欧洲国家主动脉瓣置换（AVR）的使用模式。
从 12 个欧洲国家（奥地利、捷克共和国、丹麦、英格兰、芬兰、法国、德国、挪威、波兰、西班牙、瑞典和瑞士）的国家数据库中获得 2015 年至 2020 年的 AVR 手术量数据，包括外科主动脉瓣置换术（sAVR）和经导管主动脉瓣植入术（TAVI）。手术量按患者年龄（<50 岁、50-85 岁之间的 5 岁年龄组和≥85 岁）进行报告。每年每百万人（PPM）接受 AVR 的患者数量是使用 Eurostat 的人口估计数计算得出的。
2020 年，AVR 的 PPM 在各国之间差异很大，德国为 508 PPM，波兰为 174 PPM。TAVI 率在瑞士和芬兰为 61%，在波兰为 25%。AVR 的 PPM 随年龄增长而增加，在 80-84 岁达到峰值，之后再次下降。AVR 手术量从 2015 年到 2019 年以平均每年 3.9%的速度增加。≥80 岁的患者的 AVR 手术量增长幅度大于较年轻的年龄组；这些年龄较大的年龄组在 2015 年占所有 AVR 手术的 30%，在 2019 年占 35%。随着患者年龄的增长，TAVI 在所有 AVR 手术中的比例逐渐增加；总体而言，≥85 岁的男性中有 96%，女性中有 98%接受了 TAVI 作为治疗方式，尽管各国对 TAVI 的采用存在差异。
欧洲国家之间的 AVR 使用和 TAVI 与 sAVR 的采用存在相当大的差异。近年来，TAVI 的使用有所增加，特别是在老年患者中。
