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Aortic valve replacement for aortic stenosis: Influence of centre volume on TAVR adoption rates and outcomes in France.
Willner, Nadav; Nguyen, Virginia; Prosperi-Porta, Graeme; Eltchaninoff, Helene; Burwash, Ian G; Michel, Morgane; Durand, Eric; Gilard, Martine; Dindorf, Christel; Dreyfus, Julien; Iung, Bernard; Cribier, Alain; Vahanian, Alec; Chevreul, Karine; Messika-Zeitoun, David.
Afiliación
  • Willner N; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
  • Nguyen V; Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France.
  • Prosperi-Porta G; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
  • Eltchaninoff H; Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France.
  • Burwash IG; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
  • Michel M; Paris-Cité, 75006 Paris, France; Unité d'Épidémiologie Clinique, Hôpital Robert-Debré, AP-HP, 75019 Paris, France; U1123, Inserm, ECEVE, 75010 Paris, France.
  • Durand E; Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France.
  • Gilard M; Department of Cardiology, Brest University Hospital, 29200 Brest, France.
  • Dindorf C; Paris-Cité, 75006 Paris, France; U1123, Inserm, ECEVE, 75010 Paris, France; URC Eco Île-de-France, Hôtel-Dieu, AP-HP, 75004 Paris, France.
  • Dreyfus J; Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France.
  • Iung B; Paris-Cité, 75006 Paris, France; Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, Bichat Hospital, AP-HP, 75018 Paris, France.
  • Cribier A; Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France.
  • Vahanian A; Paris-Cité, 75006 Paris, France; Inserm U1148, Bichat Hospital, AP-HP, 75018 Paris, France.
  • Chevreul K; Paris-Cité, 75006 Paris, France; Department of Cardiology, Brest University Hospital, 29200 Brest, France; URC Eco Île-de-France, Hôtel-Dieu, AP-HP, 75004 Paris, France.
  • Messika-Zeitoun D; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada. Electronic address: DMessika-zeitoun@ottawaheart.ca.
Arch Cardiovasc Dis ; 117(5): 321-331, 2024 May.
Article en En | MEDLINE | ID: mdl-38670869
ABSTRACT

BACKGROUND:

Transcatheter (TAVR) has supplanted surgical (SAVR) aortic valve replacement (AVR).

AIM:

To evaluate whether adoption of this technology has varied according to centre volume at the nationwide level.

METHODS:

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").

RESULTS:

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; PANCOVA<0.001). Charlson Comorbidity Index and in-hospital death rates declined from 2010 to 2019 in all terciles (all Ptrend<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).

CONCLUSIONS:

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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Válvula Aórtica / Estenosis de la Válvula Aórtica / Bases de Datos Factuales / Implantación de Prótesis de Válvulas Cardíacas / Hospitales de Alto Volumen / Hospitales de Bajo Volumen / Reemplazo de la Válvula Aórtica Transcatéter Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Arch Cardiovasc Dis Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Países Bajos
Texto completo
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Imprimir
XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Válvula Aórtica / Estenosis de la Válvula Aórtica / Bases de Datos Factuales / Implantación de Prótesis de Válvulas Cardíacas / Hospitales de Alto Volumen / Hospitales de Bajo Volumen / Reemplazo de la Válvula Aórtica Transcatéter Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: Arch Cardiovasc Dis Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Países Bajos