TY - JOUR
T1 - Contemporary outcomes of surgical aortic valve replacement in Japan
AU - Japan Cardiovascular Surgery Database Organization
AU - Tokuda, Yoshiyuki
AU - Yamamoto, Hiroyuki
AU - Miyata, Hiroaki
AU - Usui, Akihiko
AU - Motomura, Noboru
N1 - Funding Information:
H.Y. and H.M. are affiliated with the Department of Healthcare Quality Assessment at University of Tokyo. The department is a social collaboration department supported by grants from National Clinical Database, Johnson & Johnson, and Nipro.
Publisher Copyright:
© 2020 Japanese Circulation Society. All rights reserved.
PY - 2020
Y1 - 2020
N2 - Background: Given the rapid expansion in the use of transcatheter aortic valve implantation (TAVI), recent outcomes of surgical aortic valve replacement (SAVR) should be re-evaluated. Methods and Results: Using the data from the Japan Cardiovascular Surgery Database of 160 enrolled hospitals, trends in elective isolated SAVR were evaluated until the introduction of TAVI in Japan. Trend analyses were performed over 4 periods: period 1, 2008-2009 (4,415 cases); period 2, 2010-2011 (4,861 cases); period 3, 2012-2013 (5,674 cases); and period 4, 2014-2015 (5,563 cases). Baseline risk, evaluated on JapanSCORE, increased significantly over the 4 periods, from a median of 1.56 (IQR, 0.99-2.61) in period 1 to 2.08 (IQR, 1.33-3.96) in period 4 (P<0.001, trend test). Despite the increased risk, the composite major complication and operative mortality rate decreased significantly (10.7% in period 1 to 9.2% in period 4, P=0.01). Using a risk-adjusted model, the OR of operative mortality was 1.61 (95% CI: 1.29-2.02) in period 1 (P<0.0001) compared with period 4. An increase in the use of bioprostheses was also observed, from 60.4% to 76.8% (P<0.001) over the 4 periods. Conclusions: Even in a short 8-year period, SAVR outcomes improved in Japan. This should be taken into account when discussing the indications for aortic valve intervention.
AB - Background: Given the rapid expansion in the use of transcatheter aortic valve implantation (TAVI), recent outcomes of surgical aortic valve replacement (SAVR) should be re-evaluated. Methods and Results: Using the data from the Japan Cardiovascular Surgery Database of 160 enrolled hospitals, trends in elective isolated SAVR were evaluated until the introduction of TAVI in Japan. Trend analyses were performed over 4 periods: period 1, 2008-2009 (4,415 cases); period 2, 2010-2011 (4,861 cases); period 3, 2012-2013 (5,674 cases); and period 4, 2014-2015 (5,563 cases). Baseline risk, evaluated on JapanSCORE, increased significantly over the 4 periods, from a median of 1.56 (IQR, 0.99-2.61) in period 1 to 2.08 (IQR, 1.33-3.96) in period 4 (P<0.001, trend test). Despite the increased risk, the composite major complication and operative mortality rate decreased significantly (10.7% in period 1 to 9.2% in period 4, P=0.01). Using a risk-adjusted model, the OR of operative mortality was 1.61 (95% CI: 1.29-2.02) in period 1 (P<0.0001) compared with period 4. An increase in the use of bioprostheses was also observed, from 60.4% to 76.8% (P<0.001) over the 4 periods. Conclusions: Even in a short 8-year period, SAVR outcomes improved in Japan. This should be taken into account when discussing the indications for aortic valve intervention.
KW - Aortic valve replacement
KW - Japan Cardiovascular Surgery Database
KW - JapanSCORE
KW - Transcatheter aortic valve implantation
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U2 - 10.1253/circj.CJ-19-0674
DO - 10.1253/circj.CJ-19-0674
M3 - Article
C2 - 31932559
AN - SCOPUS:85079222063
SN - 1346-9843
VL - 84
SP - 277
EP - 282
JO - Circulation Journal
JF - Circulation Journal
IS - 2
ER -