Krzysztof Bartus1, Jerzy Sadowski1, Radoslaw Litwinowicz1, Grzegorz Filip1, Marek Jasinski2, Marek Deja3, Mariusz Kusmierczyk4, Szymon Pawlak5,6, Marek Jemielity7, Dariusz Jagielak8, Piotr Hendzel9, Piotr Suwalski10,11, Zdzisław Tobota12, Bohdan Maruszewski12, Boguslaw Kapelak1. 1. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland. 2. Department of Cardiac Surgery, University Hospital in Wroclaw, Wroclaw Medical University, Wroclaw, Poland. 3. Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. 4. Department of Cardiosurgery and Transplantology, The Cardinal Stefan Wyszynski Institute of Cardiology, Warsaw, Poland. 5. Silesian Center for Heart Disease, Zabrze, Poland. 6. Department of Cardiac Surgery, Vascular Surgery and Transplantology Silesian Medical University Katowice, Katowice, Poland. 7. Department of Cardiac Surgery and Transplantology, University Hospital of Lord Transfiguration, Poznan University of Medical Sciences, Poznan, Poland. 8. Department of Cardiac Surgery, Medical University of Gdansk, Gdansk, Poland. 9. Department of Cardiac Surgery, Medical University of Warsaw, Warsaw, Poland. 10. Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland. 11. Centre of Postgraduates Medical Education, Warsaw, Poland. 12. Department for Pediatric Cardiothoracic Surgery, Children's Memorial Health Institute, Warsaw, Poland.
Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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