Si Si1,2, Graham S Hillis3, Frank M Sanfilippo4, Julian Smith5,6, Lavinia Tran2, Christopher M Reid1,2, Tom Briffa4. 1. Centre of Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Western Australia, Australia. 2. Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. 3. Department of Cardiology, Royal Perth Hospital and Medical School, The University of Western Australia, Perth, Western Australia, Australia. 4. School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia. 5. Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia. 6. Department of Cardiothoracic Surgery, Monash Health, Melbourne, Victoria, Australia.
Abstract
BACKGROUND: This study describes the temporal changes in risk profiles and outcomes among patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) in Australia between 2002 and 2015. METHODS: Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database, we identified first-recorded SAVR for AS over 14 years. Patients' surgical risk profiles, procedures, 30-day and 12-month outcomes were summarized before and after the introduction of transcatheter aortic valve implantation in Australia, in 2008. We applied multivariable regression models to investigate the changes over time on risk-adjusted 30-day mortality, re-hospitalization and 12-month mortality. RESULTS: We identify a total of 18 147 patients with AS who underwent SAVR; mostly men (64%) with a mean age of 72 years. The proportion of major cardiac surgeries devoted to SAVR increased from 14% in 2002 to 20% in 2015. More SAVRs were performed electively (80% in 2002 versus 86% in 2015), and the recipients were at lower surgical risk (mean multi-risk score 3.9% in 2002 versus 3.0% in 2015). The use of bioprosthetic aortic valves increased over time (67% in 2002 to 88% in 2015). We found no significant changes in 30-day mortality, a significant decrease in 30-day readmission and minor fluctuations in 12-month mortality over the study period. CONCLUSION: SAVR comprises an increasingly larger proportion of all adult cardiac surgeries in Australia. There has been a greater use of bioprosthetic aortic valves, a fall in 30-day readmission but no significant changes in mortality.
BACKGROUND: This study describes the temporal changes in risk profiles and outcomes among patients with aortic stenosis (AS) undergoing surgical aortic valve replacement (SAVR) in Australia between 2002 and 2015. METHODS: Using the Australian and New Zealand Society of Cardiac and Thoracic Surgeons database, we identified first-recorded SAVR for AS over 14 years. Patients' surgical risk profiles, procedures, 30-day and 12-month outcomes were summarized before and after the introduction of transcatheter aortic valve implantation in Australia, in 2008. We applied multivariable regression models to investigate the changes over time on risk-adjusted 30-day mortality, re-hospitalization and 12-month mortality. RESULTS: We identify a total of 18 147 patients with AS who underwent SAVR; mostly men (64%) with a mean age of 72 years. The proportion of major cardiac surgeries devoted to SAVR increased from 14% in 2002 to 20% in 2015. More SAVRs were performed electively (80% in 2002 versus 86% in 2015), and the recipients were at lower surgical risk (mean multi-risk score 3.9% in 2002 versus 3.0% in 2015). The use of bioprosthetic aortic valves increased over time (67% in 2002 to 88% in 2015). We found no significant changes in 30-day mortality, a significant decrease in 30-day readmission and minor fluctuations in 12-month mortality over the study period. CONCLUSION: SAVR comprises an increasingly larger proportion of all adult cardiac surgeries in Australia. There has been a greater use of bioprosthetic aortic valves, a fall in 30-day readmission but no significant changes in mortality.
Authors: Mitchell N Sarkies; Suzanne Robinson; Tom Briffa; Stephen J Duffy; Mark Nelson; John Beltrame; Louise Cullen; Derek Chew; Julian Smith; David Brieger; Peter Macdonald; Danny Liew; Chris Reid Journal: Health Res Policy Syst Date: 2021-04-21
Authors: Oluwadamisola Temilade Sotade; Michael Falster; Leonard N Girardi; Sallie-Anne Pearson; Louisa R Jorm Journal: BMJ Surg Interv Health Technol Date: 2020-10-27