National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Abstract

Objective: The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. Results: We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). Conclusion: The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

“…The observed mortality rate has outperformed the predicted mortality rate by nearly 50% in 2016–2018. The mortality rate in the United Kingdom has further reduced since the last report ( 13 ) and other reports in the literature ( 9 , 14 ).…”

“…Our study demonstrated that SAVR remains an effective treatment with low mortality for patients with isolated aortic valve disease. The number of patients with high-risk, octogenarians undergoing isolated SAVR, and those requiring redo surgery has reduced in recent years, likely due to the (13) and other reports in the literature (9,14).…”

“…The increased use of bioprostheses we observed reflects a similar trend in the literature. Jiménez-García et al ( 9 ) reported a five-fold use of bioprostheses from 2001 to 2015 using the Spanish National Hospital Discharge Database, although the age groups were not specified. Alkhouli et al ( 8 ) reported the age group-specific use of bio/mechanical prostheses in the United States using the Nationwide Inpatient Sample.…”

“…TAVR also provides an alternative to patients with the previous SAVR/TAVR with an option of valve-in-valve transcatheter aortic valve replacement (ViV TAVR). This has been suggested to result in a reduction in mechanical valve use worldwide ( 8 , 9 ).…”

Comparison of outcome prediction models post-stroke for a population-based registry with clinical variables collected at admission vs. discharge

“…Comparing the predictors for the 30-day composite endpoint, there were important differences between first-time and repeat AVR procedures. Although female sex, age, congestive heart failure (CHF), coronary artery disease, cerebrovascular disease, and renal function were previously documented to impact first-time SAVR patients' adverse clinical outcomes [31,32] , these were not identified in the present r-AVR study. Similarly, pulmonary hypertension, renal function, and diabetes had been found to be predictors of post-TAVR adverse clinical outcomes in a prior study [33] .…”