Abstract P52: Epidemiology of Heart Valve Repair and Replacement Procedures in the United States: A 15-Year Perspective

Abstract

Open heart valve repair/replacement is widely used to treat various valvular pathologies. The development of percutaneous valve replacement technology may pave the way for less invasive treatment options. This study characterized the epidemiology of valvular repair and replacement procedures in the U.S. The Nationwide Inpatient Sample (NIS) was used to identify closed and open heart valvotomy, heart valve replacement, annuloplasty, and percutaneous valvotomy procedures between 1993 and 2007. NIS is an annual survey of ∼1,000 hospitals and contains 20% of the U.S. inpatient hospitalizations. The prevalence of these procedures was calculated as a function of age, gender, race, census region, and type of hospital. 3,342 closed heart valvotomy, 191,141 closed heart valvotomy, 1,078,388 heart valve replacement, 106,110 annuloplasty, and 35,071 percutaneous valvotomy procedures were identified. Heart valve replacements included 302,932, 89,249, 13,828, and 4,680 aortic, mitral, pulmonary, and tricuspid valve procedures with tissue graft, respectively, and 479,168, 253,804, 3,904, and 7,494 prosthetic aortic, mitral, pulmonary, and tricuspid valve procedures, respectively. In contrast to valvotomy procedures, the majority of heart valve replacements (64.0%) and annuloplasty (57.7%) were performed on elderly patients (>=65 years). Most repair/replacement procedures were performed on men, except for percutaneous valvotomy (41.9%). Regional variations were found; for example, closed valvotomy were disproportionately performed in South (44.2%). The vast majority of procedures were performed in urban, non-teaching and large hospitals. Databases such as the NIS allow the characterization of the epidemiology for heart valve repair/replacement patients in a large, nationally representative patient sample. Our study demonstrates that these procedures vary considerably by patient demographics and geographic region. Additional research will help assess if the epidemiology will change over time, as the use of new technologies such as percutaneous heart valve devices grows. In the future, longitudinal administrative databases, such as Medicare, provide a mechanism to evaluate the comparative effectiveness of these procedures.