Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France.
Arch Cardiovasc Dis. 2024 May;117(5):321-331. doi: 10.1016/j.acvd.2024.02.007. Epub 2024 Apr 12.
Transcatheter (TAVR) has supplanted surgical (SAVR) aortic valve replacement (AVR).
To evaluate whether adoption of this technology has varied according to centre volume at the nationwide level.
From an administrative hospital-discharge database, we collected data on all AVRs performed in France between 2007 and 2019. Centres were divided into terciles based on the annual number of SAVRs performed in 2007-2009 ("before TAVR era").
A total of 192,773 AVRs (134,662 SAVRs and 58,111 TAVRs) were performed in 47 centres. The annual number of AVRs and TAVRs increased significantly and linearly in low-volume (<152 SAVRs/year; median 106, interquartile range [IQR] 75-129), middle-volume (152-219 SAVRs/year; median 197, IQR 172-212) and high-volume (>219 SAVRs/year; median 303, IQR 268-513) terciles, but to a greater degree in the latter (+14, +16 and +24 AVRs/centre/year and +16, +19 and +31 TAVRs/centre/year, respectively; P<0.001). Charlson Comorbidity Index and in-hospital death rates declined from 2010 to 2019 in all terciles (all P<0.05). In 2017-2019, after adjusting for age, sex and Charlson Comorbidity Index, there was a trend toward lower death rates in the high-volume tercile (P=0.06) for SAVR, whereas death rates were similar for TAVR irrespective of tercile (P=0.27). Similar results were obtained when terciles were defined based on number of interventions performed in the last instead of the first 3years. Importantly, even centres in the lowest-volume tercile performed a relatively high number of interventions (150 TAVRs/year/centre).
In a centralized public healthcare system, the total number of AVRs increased linearly between 2007 and 2019, mostly due to an increase in TAVR, irrespective of centre volume. Progressive declines in patient risk profiles and death rates were observed in all terciles; in 2017-2019 death rates were similar in all terciles, although lower in high-volume centres for SAVR.
经导管（TAVR）已取代外科（SAVR）主动脉瓣置换术（AVR）。
评估在全国范围内，该技术的采用是否因中心数量而异。
我们从医院行政出院数据库中收集了 2007 年至 2019 年期间在法国进行的所有 AVR 数据。根据 2007-2009 年每年进行的 SAVR 数量（“TAVR 前时代”），将中心分为三分之一。
47 家中心共进行了 192773 例 AVR（134662 例 SAVR 和 58111 例 TAVR）。低容量（<152 例 SAVR/年；中位数 106，四分位距[IQR] 75-129）、中容量（152-219 例 SAVR/年；中位数 197，IQR 172-212）和高容量（>219 例 SAVR/年；中位数 303，IQR 268-513）三组的 AVR 和 TAVR 数量均显著呈线性增加，但后者增加幅度更大（+14、+16 和+24 例/中心/年和+16、+19 和+31 例 TAVR/中心/年；P<0.001）。2010 年至 2019 年，所有三分位数的 Charlson 合并症指数和院内死亡率均下降（均 P<0.05）。2017-2019 年，调整年龄、性别和 Charlson 合并症指数后，高容量三分位数的 SAVR 死亡率呈下降趋势（P=0.06），而 TAVR 死亡率与三分位数无关（P=0.27）。基于过去 3 年而非前 3 年进行的干预次数定义三分位数时，也得到了类似的结果。重要的是，即使是低容量三分位数的中心也进行了相对较多的干预（150 例 TAVR/中心/年）。
在集中的公共医疗保健系统中，2007 年至 2019 年 AVR 总数呈线性增加，这主要是由于 TAVR 的增加所致，而与中心数量无关。所有三分位数的患者风险状况和死亡率均呈下降趋势；2017-2019 年，所有三分位数的死亡率相似，尽管 SAVR 高容量中心的死亡率较低。
