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Willner N, Nguyen V, Prosperi-Porta G, Eltchaninoff H, Burwash IG, Michel M, Durand E, Gilard M, Dindorf C, Dreyfus J, Iung B, Cribier A, Vahanian A, Chevreul K, Messika-Zeitoun D. Aortic valve replacement for aortic stenosis: Influence of centre volume on TAVR adoption rates and outcomes in France. Arch Cardiovasc Dis 2024:S1875-2136(24)00053-6. [PMID: 38670869 DOI: 10.1016/j.acvd.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND Transcatheter (TAVR) has supplanted surgical (SAVR) aortic valve replacement (AVR). AIM To evaluate whether adoption of this technology has varied according to centre volume at the nationwide level. METHODS From an administrative hospital-discharge database, we collected data on all AVRs performed in France between 2007 and 2019. Centres were divided into terciles based on the annual number of SAVRs performed in 2007-2009 ("before TAVR era"). RESULTS A total of 192,773 AVRs (134,662 SAVRs and 58,111 TAVRs) were performed in 47 centres. The annual number of AVRs and TAVRs increased significantly and linearly in low-volume (<152 SAVRs/year; median 106, interquartile range [IQR] 75-129), middle-volume (152-219 SAVRs/year; median 197, IQR 172-212) and high-volume (>219 SAVRs/year; median 303, IQR 268-513) terciles, but to a greater degree in the latter (+14, +16 and +24 AVRs/centre/year and +16, +19 and +31 TAVRs/centre/year, respectively; PANCOVA<0.001). Charlson Comorbidity Index and in-hospital death rates declined from 2010 to 2019 in all terciles (all Ptrend<0.05). In 2017-2019, after adjusting for age, sex and Charlson Comorbidity Index, there was a trend toward lower death rates in the high-volume tercile (P=0.06) for SAVR, whereas death rates were similar for TAVR irrespective of tercile (P=0.27). Similar results were obtained when terciles were defined based on number of interventions performed in the last instead of the first 3years. Importantly, even centres in the lowest-volume tercile performed a relatively high number of interventions (150 TAVRs/year/centre). CONCLUSIONS In a centralized public healthcare system, the total number of AVRs increased linearly between 2007 and 2019, mostly due to an increase in TAVR, irrespective of centre volume. Progressive declines in patient risk profiles and death rates were observed in all terciles; in 2017-2019 death rates were similar in all terciles, although lower in high-volume centres for SAVR.
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Affiliation(s)
- Nadav Willner
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Virginia Nguyen
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Graeme Prosperi-Porta
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Helene Eltchaninoff
- Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France
| | - Ian G Burwash
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Morgane Michel
- Paris-Cité, 75006 Paris, France; Unité d'Épidémiologie Clinique, Hôpital Robert-Debré, AP-HP, 75019 Paris, France; U1123, Inserm, ECEVE, 75010 Paris, France
| | - Eric Durand
- Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France
| | - Martine Gilard
- Department of Cardiology, Brest University Hospital, 29200 Brest, France
| | - Christel Dindorf
- Paris-Cité, 75006 Paris, France; U1123, Inserm, ECEVE, 75010 Paris, France; URC Eco Île-de-France, Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - Julien Dreyfus
- Cardiology Department, Centre Cardiologique du Nord, 93200 Saint-Denis, France
| | - Bernard Iung
- Paris-Cité, 75006 Paris, France; Department of Cardiology, Bichat Hospital, AP-HP, 75018 Paris, France; Inserm U1148, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Alain Cribier
- Department of Cardiology, CHU de Rouen, U1096, Normandie Université, UNIROUEN, 76000 Rouen, France
| | - Alec Vahanian
- Paris-Cité, 75006 Paris, France; Inserm U1148, Bichat Hospital, AP-HP, 75018 Paris, France
| | - Karine Chevreul
- Paris-Cité, 75006 Paris, France; Department of Cardiology, Brest University Hospital, 29200 Brest, France; URC Eco Île-de-France, Hôtel-Dieu, AP-HP, 75004 Paris, France
| | - David Messika-Zeitoun
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada.
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Naito S, Demal TJ, Sill B, Reichenspurner H, Onorati F, Gatti G, Mariscalco G, Faggian G, Salsano A, Santini F, Santarpino G, Zanobini M, Musumeci F, Rubino AS, Bancone C, De Feo M, Nicolini F, Dalén M, Speziale G, Bounader K, Mäkikallio T, Tauriainen T, Ruggieri VG, Perrotti A, Biancari F. Impact of Surgeon Experience and Centre Volume on Outcome After Off-Pump Coronary Artery Bypass Surgery: Results From the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) Registry. Heart Lung Circ 2023; 32:387-394. [PMID: 36566143 DOI: 10.1016/j.hlc.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/17/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
AIM The aim of this study was to assess the impact of surgeon experience and centre volume on early operative outcomes in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. METHOD Of 7,352 patients in the European Multicenter Study on Coronary Artery Bypass Grafting (E-CABG) registry, 1,549 underwent OPCAB and were included in the present analysis. Using adjusted regression analysis, we compared major early adverse events after procedures performed by experienced OPCAB surgeons (i.e., ≥20 cases per year; n=1,201) to those performed by non-OPCAB surgeons (n=348). Furthermore, the same end points were compared between procedures performed by OPCAB surgeons in high OPCAB volume centres (off-pump technique used in >50% of cases; n=894) and low OPCAB volume centres (n=307). RESULTS In the experienced OPCAB surgeon group, we observed shorter procedure times (β -43.858, 95% confidence interval [CI] -53.322 to -34.393; p<0.001), a lower rate of conversion to cardiopulmonary bypass (odds ratio [OR] 0.284, 95% CI 0.147-0.551; p<0.001), a lower rate of prolonged inotrope or vasoconstrictor use (OR 0.492, 95% CI 0.371-0.653; p<0.001), a lower rate of early postprocedural percutaneous coronary interventions (OR 0.335, 95% CI 0.169-0.663; p=0.002), and lower 30-day mortality (OR 0.423, 95% CI 0.194-0.924; p=0.031). In high OPCAB volume centres, we found a lower rate of prolonged inotrope use (OR 0.584, 95% CI 0.419-0.814; p=0.002), a lower rate of postprocedural acute kidney injury (OR 0.382, 95% CI 0.198-0.738; p=0.004), shorter duration of intensive care unit (β -1.752, 95% CI -2.240 to -1.264; p<0.001) and hospital (β -1.967; 95% CI -2.717 to -1.216; p<0.001) stays, and lower 30-day mortality (OR 0.316, 95% CI 0.114-0.881; p=0.028). CONCLUSIONS Surgeon experience and centre volume may play an important role on the early outcomes after OPCAB surgery.
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Affiliation(s)
- Shiho Naito
- Department of Cardiovascular Surgery, University Heart & Vascular Centre Hamburg, Hamburg, Germany.
| | - Till J Demal
- Department of Cardiovascular Surgery, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Björn Sill
- Department of Cardiovascular Surgery, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart & Vascular Centre Hamburg, Hamburg, Germany
| | - Francesco Onorati
- Department of Cardiac Surgery, Verona University Hospital, Verona, Italy
| | - Giuseppe Gatti
- Cardiothoracic and Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Giovanni Mariscalco
- Department of Cardiovascular Sciences, University Hospitals of Leicester NHS Trust, Glenfield Hospital, Leicester, UK
| | - Giuseppe Faggian
- Cardiothoracic and Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Antonio Salsano
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy; DISC Department, University of Genoa, Genoa, Italy
| | - Francesco Santini
- Division of Cardiac Surgery, IRCCS Ospedale Policlinico San Martino, University of Genoa, Genoa, Italy; DISC Department, University of Genoa, Genoa, Italy
| | - Giuseppe Santarpino
- Department of Clinical and Experimental Medicine, Magna Graecia University, Catanzaro, Italy; Department of Cardiac Surgery, Cittá di Lecce Hospital, GVM Lecce, Italy; Department of Cardiac Surgery, Klinikum Nürnberg, Paracelsus Medical University, Nürnberg, Germany
| | - Marco Zanobini
- Department of Cardiac Surgery, Centro Cardiologico - Fondazione Monzino IRCCS, Milan, Italy
| | - Francesco Musumeci
- Unit of Cardiac Surgery, Department of Cardiosciences, Hospital S. Camillo-Forlanini, Rome, Italy
| | - Antonino S Rubino
- Department of Cardiac Surgery, Centro Cuore, Pedara, Italy; Cardio-Thoraco-Vascular Department, Division of Cardiac Surgery, Papardo Hospital, Messina, Italy
| | - Ciro Bancone
- Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marisa De Feo
- Department of Cardiothoracic Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | | | - Magnus Dalén
- Department of Molecular Medicine and Surgery, Department of Cardiothoracic Surgery Karolinska Institute Karolinska University Hospital, Stockholm, Sweden
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care & Research, Bari, Italy
| | - Karl Bounader
- Division of Cardiothoracic and Vascular Surgery, Pontchaillou University Hospital, Rennes, France
| | - Timo Mäkikallio
- Department of Medicine, South-Karelja Central Hospital, Lappeenranta, University of Helsinki, Helsinki, Finland; Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Tuomas Tauriainen
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland
| | - Vito G Ruggieri
- Division of Cardiothoracic and Vascular Surgery, Robert Debré University Hospital, Université Reims Champagne Ardenne, Reims, France
| | - Andrea Perrotti
- Department of Thoracic and Cardiovascular Surgery, University Hospital Jean Minjoz, Besançon, France
| | - Fausto Biancari
- Department of Internal Medicine, Oulu University Hospital, Oulu, Finland; Department of Clinica Montevergine, GVM Care & Research, Mercogliano, Italy; Department of Heart and Lung Centre, Helsinki University Hospital, Helsinki, Finland
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Vassilikos VP, Pagourelias ED, Laroche C, Blomström-Lundqvist C, Kautzner J, Maggioni AP, Tavazzi L, Dagres N, Brugada J, Stühlinger M, Arbelo E. Impact of centre volume on atrial fibrillation ablation outcomes in Europe: a report from the ESC EHRA EORP Atrial Fibrillation Ablation Long-Term (AFA LT) Registry. Europace 2021; 23:49-58. [PMID: 33141150 DOI: 10.1093/europace/euaa236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 07/05/2020] [Accepted: 07/12/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS The aim of the study was to investigate differences in clinical outcomes and complication rates among European atrial fibrillation (AF) ablation centres related to the volume of AF ablations performed. METHODS AND RESULTS Data for this analysis were extracted from the ESC EHRA EORP European AF Ablation Long-Term Study Registry. Based on 33rd and 67th percentiles of number of AF ablations performed, the participating centres were classified into high volume (HV) (≥ 180 procedures/year), medium volume (MV) (<180 and ≥74/year), and low volume (LV) (<74/year). A total of 91 centres in 26 European countries enrolled in 3368 patients. There was a significantly higher reporting of cardiovascular complications and stroke incidence in LV centres compared with HV and MV (P = 0.039 and 0.008, respectively) and a lower success rate after AF ablation (55.3% in HV vs. 57.2% in LV vs. 67.4% in MV centres, P < 0.001), despite lower CHA2DS2-VASc score of patients, enrolled in LVs and less complex ablation techniques used. Adjustments of confounding factors (including type of AF ablation) led to elimination of these differences. CONCLUSION Low-volume centres tended to present slightly higher cardiovascular complications' and stroke incidence and a lower unadjusted success rate after AF ablation, despite the fact that ablation procedures and patients were of lower risk compared with MV and HV centres. On the other hand, adjusted overall complication and recurrence rates were non-significantly different among different volume centres, a fact reflecting the heterogeneity of patient and procedural profiles, and a counterbalance between expertise and risk level among participating centres.
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Affiliation(s)
- Vassilios P Vassilikos
- Third Department of Cardiology, Hippokrateion General Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos str, 54642 Thessaloniki, Greece
| | - Efstathios D Pagourelias
- Third Department of Cardiology, Hippokrateion General Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos str, 54642 Thessaloniki, Greece
| | - Cécile Laroche
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France
| | | | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine (ΙΚΕΜ), Prague, Czech Republic
| | - Aldo P Maggioni
- EURObservational Research Programme (EORP), European Society of Cardiology, Sophia-Antipolis, France.,ANMCO Research Centre, Florence, Italy
| | - Luigi Tavazzi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Nikolaos Dagres
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Josep Brugada
- Hospital Clínic Pediatric Arrhythmia Unit, Cardiovascular Institute, Hospital Sant Joan de Déu University of Barcelona, Barcelona, Spain
| | - Markus Stühlinger
- Clinic of Internal Medicine III/Cardiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Elena Arbelo
- Department of Cardiology, Cardiovascular Institut, Hospital Clinic de Barcelona, Universitat de Barcelona, Barcelona, Spain.,Instit d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Di Monaco A, Pelargonio G, Narducci ML, Manzoli L, Boccia S, Flacco ME, Capasso L, Barone L, Perna F, Bencardino G, Rio T, Leo M, Di Biase L, Santangeli P, Natale A, Rebuzzi AG, Crea F. Safety of transvenous lead extraction according to centre volume: a systematic review and meta-analysis. Europace 2014; 16:1496-507. [PMID: 24965015 DOI: 10.1093/europace/euu137] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Transvenous lead extraction (TLE) is a complex invasive procedure and the experience of the operator and the team is a major determinant of procedural outcomes. AIM Because of very limited data available on minimum procedural volumes to enable training and ongoing competency for TLEs, we performed a meta-analysis aimed at assessing the outcomes of TLE in the centres with low, medium, and high volume of procedures. METHODS Of the 280 papers initially retrieved until February 2013, 66 observational studies met inclusion criteria and were included in at least one stratified meta-analysis: 17 were prospective studies; 47 had a retrospective design; and 2 were defined 'experience studies'. We included only articles published after the introduction of laser technique (year 1999). We divided the studies in low, medium, and high volume centres utilizing either the European Heart Rhythm Association (EHRA) or Lexicon classification criteria. RESULTS When meta-analyses were carried out separately for the studies with larger and smaller sample sizes, either using EHRA or Lexicon classification criteria, no clear differences emerged in the combined rate of major complications or intraoperative deaths. In contrast, both minor complications and mortality at 30 days decreased as centre volume increased. CONCLUSIONS In our meta-analysis of observational studies, patients who have been treated in higher volume centres have a lower probability of minor complications and death at 30 days regardless of the infection rate, length of lead duration, type of device, and type of extraction.
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Affiliation(s)
- Antonio Di Monaco
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Lamberto Manzoli
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Stefania Boccia
- Institute of Hygiene, Catholic University of Sacred Heart, Rome, Italy
| | - Maria Elena Flacco
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lorenzo Capasso
- Department of Medicine and Aging Sciences, University 'G D'Annunzio' Chieti, Chieti, Italy
| | - Lucy Barone
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Gianluigi Bencardino
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Teresa Rio
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Milena Leo
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Luigi Di Biase
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA Department of Cardiology, University of Foggia, Foggia, Italy
| | - Pasquale Santangeli
- Department of Cardiology, University of Foggia, Foggia, Italy Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
| | - Antonio Giuseppe Rebuzzi
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Cardiology Institute, Catholic University of Sacred Heart, Rome, Italy
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