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. 2019 Jun;11(6):2340-2349.
doi: 10.21037/jtd.2019.06.04.

Changing trends in aortic valve procedures over the past ten years-from mechanical prosthesis via stented bioprosthesis to TAVI procedures-analysis of 50,846 aortic valve cases based on a Polish National Cardiac Surgery Database

Krzysztof Bartus  1 , Jerzy Sadowski  1 , Radoslaw Litwinowicz  1 , Grzegorz Filip  1 , Marek Jasinski  2 , Marek Deja  3 , Mariusz Kusmierczyk  4 , Szymon Pawlak  5   6 , Marek Jemielity  7 , Dariusz Jagielak  8 , Piotr Hendzel  9 , Piotr Suwalski  10   11 , Zdzisław Tobota  12 , Bohdan Maruszewski  12 , Boguslaw Kapelak  1
Affiliations

Changing trends in aortic valve procedures over the past ten years-from mechanical prosthesis via stented bioprosthesis to TAVI procedures-analysis of 50,846 aortic valve cases based on a Polish National Cardiac Surgery Database

Krzysztof Bartus et al. J Thorac Dis. 2019 Jun.

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.

Keywords: Aortic valve replacement (AVR); bioprostheses; heart valve prosthesis; mechanical prosthesis; transcatheter aortic valve implantation (TAVI).

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Number of procedures performed in each year (data complete 100%).
Figure 2
Figure 2
Mean patient age (P<0.000001) (data complete 100%).
Figure 3
Figure 3
Type of valve pathology.
Figure 4
Figure 4
All AV procedures performed from 2006–2016 (100% complete data). AV, aortic valve; CABG, coronary artery bypass grafting; MV, mitral valve; TAVI, transcatheter aortic valve implantation; TV, tricuspid valve; PV, pulmonary valve.
Figure 5
Figure 5
Characteristics of all AV procedures performed from 2006–2016 (100% complete data). AV, aortic valve; CABG, coronary artery bypass grafting; TAVI, transcatheter aortic valve implantation; MV, mitral valve.
Figure 6
Figure 6
Proportion of all implanted prostheses in each year (97% complete data). TAVI, transcatheter aortic valve implantation.
Figure 7
Figure 7
Types of all implanted prostheses from 2006–2016 (97% complete data).
Figure 8
Figure 8
Prosthesis valve size.
Figure 9
Figure 9
In-hospital mortality in AV procedures from 2006–2016. AV, aortic valve; TAVI, transcatheter aortic valve implantation; CABG, coronary artery bypass grafting; MV, mitral valve.
See this image and copyright information in PMC

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