Implementation of Transcatheter Aortic Valve Replacement in France
Implementation of Transcatheter Aortic Valve Replacement in France
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DOI：
10.1016/j.jacc.2018.01.079
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发表时间：
2018-04-17
影响因子：
24
通讯作者：
Messika-Zeitoun, David
中科院分区：
文献类型：
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作者：
Nguyen, Virginia;Michel, Morgane;Messika-Zeitoun, David
背景 经导管主动脉瓣置换术 (TAVR) 已成为外科主动脉瓣置换术 (SAVR) 的替代方案，但有关全国范围内主动脉瓣狭窄患者治疗进展的公正数据很少。 目的 本研究旨在评估法国进行的主动脉瓣置换术 (AVR) 的数量、随时间的变化以及采用 TAVR 的效果。 方法 基于法国医院出院管理数据库，研究收集了 2007 年至 2015 年间在法国进行的所有连续 AVR。 结果 总共进行了 131,251 次干预：109,317 次 (83%) SAVR 和 21,934 次 (17%) TAVR。 AVR 线性增加（从 10,892 到 18,704；趋势 p < 0.0001），主要是由于 TAVR 显着增加（从 244 到 6,722；趋势 p = 0.0004），而 SAVR 保持稳定（从 10,892 到 11,982；趋势 p = 0.18）。与 Charlson 指数下降（趋势 p < 0.05）平行，SAVR 和 TAVR 院内死亡率显着下降（趋势 p < 0.01）。所有年龄类别（< 75、75 至 79、80 至 84 岁和 >= 85 岁；所有趋势 p = 0.003）的 TAVR 数量均显着增加，但在 2 个最古老的类别中达到甚至超过 SAVR。尽管单纯 SAVR 和 TAVR 的死亡率均有所下降，但 2015 年，在 3 个最老年龄组中，TAVR 的死亡率与单纯 SAVR 相似或略低，即使未达到统计学显着性（分别为 p = 0.66、p = 0.47 和 p = 0.06）。 结论 由于 TAVR 的广泛采用，2007 年至 2015 年间法国 AVR 的数量显着增加，占 2015 年所有 AVR 的三分之一。患者情况有所改善，表明患者可以更早转诊，并且所有 AVR 亚组的院内死亡率均有所下降。尽管临床情况较差，但对于 75 岁以上的患者，TAVR 的直接结果优于单纯 SAVR。结果可能对临床实践和政策制定者产生重大影响。 (c) 2018 年，美国心脏病学会基金会。
BACKGROUND Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), but unbiased data regarding evolution of the treatment of patients with aortic stenosis at the nationwide level are scarce.OBJECTIVES This study sought to evaluate the number of aortic valve replacements (AVRs) performed in France, changes over time, and the effect of the adoption of TAVR.METHODS Based on a French administrative hospital-discharge database, the study collected all consecutive AVRs performed in France between 2007 and 2015.RESULTS A total of 131,251 interventions were performed: 109,317 (83%) SAVR and 21,934 (17%) TAVR. AVR linearly increased (from 10,892 to 18,704; p for trend < 0.0001) mainly due to a marked increase in TAVR (from 244 to 6,722; p for trend = 0.0004), whereas SAVR remained stable (from 10,892 to 11,982; p for trend = 0.18). Parallel to a decrease in the Charlson index (p for trend < 0.05), SAVR and TAVR in-hospital mortality rates significantly declined (both p for trend < 0.01). The number of TAVRs significantly increased in all age categories (< 75, 75 to 79, 80 to 84, and >= 85 years of age; all p for trend = 0.003), but reached or even exceeded SAVR in the 2 oldest categories. Although mortality rates declined for both isolated SAVR and TAVR, it became similar or slightly lower for TAVR than for isolated SAVR in 2015 in the 3 oldest age categories even if it did not reach statistical significance (p = 0.66, p = 0.47, and p = 0.06, respectively).CONCLUSIONS The number of AVRs markedly increased in France between 2007 and 2015 due to the wide adoption of TAVR, which represented one-third of all AVRs in 2015. Patients' profile improved, suggesting that patients are referred earlier, and in-hospital mortality declined in all AVR subsets. Despite a worse clinical profile, the immediate outcome of TAVR compared favorably to isolated SAVR in patients >75 years of age. The results may have major implications for clinical practice and policymakers. (c) 2018 by the American College of Cardiology Foundation.