Implementation of transcatheter aortic valve replacement in California: Influence on aortic valve surgery

The Journal of Thoracic and Cardiovascular Surgery

Steven Maximus¹  Richard Shemin²  Jeffrey C. Milliken³  Beate Danielsen⁴ 

[1] Division of Cardiothoracic Surgery, Department of Surgery, University of California Irvine Medical Center, Orange, Calif;East Bay Cardiac Surgery Center, Oakland, Calif;Health Information Solutions, Rocklin, Calif;University of California Los Angeles Ronald Reagan Medical Center, Los Angeles, Calif

关键词: transcatheter aortic vavle replament;    surgical aortic valve replacement;    TAVR;    SAVR;   

DOI  :  10.1016/j.jtcvs.2017.07.092

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveTranscatheter aortic valve replacement (TAVR) procedures were introduced in 2011. Initially, procedures were limited to patients who were not surgical candidates, but subsequently high-risk surgical candidates were considered for TAVR. The influence on aortic valve surgery in California is unknown.MethodsThe California Office of Statewide Health Planning and Development hospitalized patient discharge database was queried for the years 2009 through 2014. isolated surgical aortic valve and aortic valve/coronary artery bypass graft (SAVR) and TAVR procedures were identified by International Classification of Diseases-9th revision clinical modification procedure codes. Seven TAVR programs were introduced in 2011, 12 in 2012, 3 in 2013, and 6 in 2014. SAVR procedure volumes were compared from the 2 years before institution with SAVR volumes during the year(s) after institution of the TAVR program in these 28 hospitals.ResultsOverall, surgical volumes increased during the first, second, and third years after implementation of TAVR procedures. Among 7 hospitals with 4-year programs, surgical volumes increased to a maximum of 15.5% during the third year, then began to decrease. The hospital performing the largest number of TAVR procedures showed a marked decrease in SAVR volume by the fourth year, suggesting a shift of SAVR candidates to TAVR. Among all hospitals with 4-year programs, TAVR exceeded SAVR procedures by the fourth year. In California overall, SAVR increased during 2011 through 2013, due primarily to increasing volume of isolated SAVR procedures. Statewide, isolated SAVR increased from a yearly average of 3111 procedures during 2009-2010 to 3592 (+15.5%) in 2013, then decreased slightly in 2014. SAVR plus coronary artery bypass graft procedures decreased during the same time period.ConclusionsAfter implementation of TAVR, hospital SAVR volumes increased moderately, then began to decrease by the fourth year, when TAVR volume exceeded SAVR. Surgical candidates may be identified during evaluation for TAVR, resulting in increased SAVR volume. Increasing SAVR volume may also be related to improved patient and provider awareness of aortic valve disease.

【 授权许可】

Unknown