Variablity of Mechanical or Tissue Valve Implantation in Patients Undergoing Surgical Aortic Valve Replacement in Spain: National Retrospective Analysis from 2007 to 2018.

Manuel Carnero-Alcázar,Emiliano Rodríguez-Caulo,Lourdes Montero-Cruces,Javier Cobiella-Carnicer,David Fernández-De Velasco,Daniel Hernández-Vaquero,Daniel Perez-Camargo,Luis Maroto-Castellanos

doi:10.3390/jcm10153209

Abstract

Background: There is no robust evidence regarding the types of valves implanted among patients undergoing surgical aortic valve replacement (SAVR) in Spain. Methods: All cases of patients undergoing SAVR ± coronary artery bypass grafting from January 2007 to December 2018 in the public Spanish National Health System were included. We analyzed the trends of SAVR volume, risk profile and type of implanted valve across time and place. Using multivariable logistic regression, we identified factors associated with biological SAVR. Results: In total, 62,870 episodes of SAVR in 15 Spanish territories were included. In 35,693 (56.8%), a tissue valve was implanted. The annual volume of procedures increased from 107.3/million (2007) to 128.6 (2017). In 2018, it fell to 108.5. Age increased and Charlson’s comorbity index worsened throughout the study period. Tissue valve implantation increased in most regions. After adjusting for other covariates, we observed a high variability in aortic valve implantation across different regions, with differences of as much as 20-fold in the use of tissue valves. Conclusions: Between 2007 and 2018, we detected a significant increase in the use of bioprostheses in patients undergoing SAVR in Spain, and a great variability in the types of valve between the Spanish territories, which was not explained by the different risk profiles of patients.

Highlights

The number of cases of aortic valvular disease will increase because of the strong association between valvular disease and age, combined with the rapid aging of populations worldwide [1]
Spain is one of the countries with the longest life expectancy in the world [13], and it has a high prevalence of aortic stenosis
Records of all episodes from 2009 to 2018 from centers belonging to the National Health System (NHS) were retrieved from the MBDS

Summary

Introduction

The number of cases of aortic valvular disease will increase because of the strong association between valvular disease and age, combined with the rapid aging of populations worldwide [1]. Transcatheter aortic valve replacement (TAVR) has increased exponentially in the last decade due to the growing evidence of its safety and efficacy [2,3], and the increasing age of patients [4,5]. Surgical aortic valve replacement (SAVR) continues to be indicated in patients with symptomatic advanced aortic valve disease or ventricular dysfunction, to improve symptoms and life expectancy [6,7]. The individual preference of the patients is the first factor when choosing between a biological and mechanical prosthesis in patients undergoing SAVR. The increase in the use of biological over mechanical valves has been evident in Western countries [10,11,12]. There is no robust evidence regarding the types of valves implanted among patients undergoing surgical aortic valve replacement (SAVR) in Spain.

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