Aortic valve replacement for aortic stenosis: Influence of centre volume on TAVR adoption rates and outcomes in France - 01/06/24
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.
Artículo gratuito.
Conéctese para beneficiarse!
Graphical abstract |
Highlights |
• | The total number of AVRs increased linearly between 2007 and 2019. |
• | AVR increased mostly due to an increase in TAVR, irrespective of centre volume. |
• | Progressive decline in risk profiles and death rates in all volume terciles. |
• | 2017–19: trend towards lower SAVR in-hospital death rates in high-volume centres. |
• | 2017–19: TAVR in-hospital death rates similar across volume terciles. |
• | Findings inform policymakers in charge of the organization of healthcare systems. |
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.
El texto completo de este artículo está disponible en PDF.Keywords : Aortic stenosis, Aortic valve replacement, Outcome, Centre volume
Abbreviations : ANCOVA, AP–HP, AVR, IQR, PMSI, SAVR, TAVR, TVT
Esquema
Vol 117 - N° 5
P. 321-331 - mai 2024 Regresar al número
Artículo precedente
- Wearable electrocardiogram devices in patients with congenital long QT syndrome: The SMART-QT study
- Antoine Delinière, Francis Bessière, Leslie Placide, Jean-Luc Pasquié, Christelle Haddad, Solenn Tirel, Hajira Mokhtar, Elodie Morel, Kevin Gardey, Arnaud Dulac, Geoffroy Ditac, Frédéric Sacher, Isabelle Denjoy, Philippe Chevalier
- Rationale and design of the PACIFIC-PRESERVED (PhenomApping, ClassIFication and Innovation for Cardiac dysfunction in patients with heart failure and PRESERVED left ventricular ejection fraction) study
- Jean-Sébastien Hulot, Philip Janiak, Philippe Boutinaud, Pierre Boutouyrie, Frédérique Chézalviel-Guilbert, Jean-Joseph Christophe, Ariel Cohen, Thibaud Damy, Juliette Djadi-Prat, Hüseyin Firat, Pierre-Yves Hervé, Richard Isnard, Guillaume Jondeau, Elie Mousseaux, Mathieu Pernot, Pierre Prot, Benoit Tyl, Gilles Soulat, Damien Logeart, PACIFIC consortium
Bienvenido a EM-consulte, la referencia de los profesionales de la salud.