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.

摘要 目的：本研究旨在探讨外科主动脉瓣置换术（surgical aortic valve replacement, SAVR）的发生率与院内结局，并依据术中植入瓣膜类型，分析接受外科主动脉瓣置换术患者的住院期间死亡率（in-hospital mortality, IHM）相关影响因素。方法：本研究基于2001年至2015年西班牙国家医院出院数据库（Spanish National Hospital Discharge Database）开展回顾性研究，纳入出院报告中标记有外科主动脉瓣置换术操作的患者。结果：本研究共纳入86578例接受外科主动脉瓣置换术的患者，其中机械瓣膜置换占52.78%，生物瓣膜置换占47.22%。外科主动脉瓣置换术的编码发生率从2001年的每10万居民11.95例显著升至2015年的17.92例（P<0.001）。患者的年龄与合并症占比随时间显著升高（P<0.001）。同期，联合冠状动脉旁路移植术（coronary artery bypass grafting, CABG）的手术比例与起搏器植入术的应用率均显著上升。机械瓣膜置换术的应用比例随时间逐渐下降，而生物瓣膜置换术的应用比例则持续升高。住院期间死亡率随时间呈下降趋势，从2001-2005年的8.13%降至2011-2015年的5.39%。接受机械瓣膜置换术的患者住院期间死亡率高于接受生物瓣膜置换术的患者（7.44% vs. 6%；P<0.05）。更高的住院期间死亡率与高龄、女性性别、合并症、联合冠状动脉旁路移植术以及机械瓣膜置换术显著相关（比值比OR=1.67；95%置信区间1.57-1.77）。结论：自2001年以来，西班牙开展的外科主动脉瓣置换术例数持续增长。机械瓣膜置换术的应用比例逐渐下降，而生物瓣膜置换术的应用比例随时间不断升高。尽管同期患者的年龄与合并症占比均有所上升，但两种瓣膜置换术的住院期间死亡率均呈下降趋势。