Aortic Valve Diseases in Croatia in 2014 and Their Treatment

    Authors

    DOI

    https://doi.org/10.15836/ccar.2015.126

    Full Text

    Surgical treatment of aortic valve disease in the Republic of Croatia is a surgical procedure that has a very important place in the overall operating procedures in cardiac surgery centers. According to the reports of all six cardiac surgery centers, aortic valve procedures make up 23% of total procedures performed, which in absolute numbers means 636 aortic valve surgeries in 2014 (Figure 1). In comparison with data from 2012 (1), there has been an increase in the number of aortic valve procedures of about 8% during the last three years. This is in line with the needs based on the incidence of the disease, especially coronary pathology that stands side to side with coronary pathology with which it shares risk factors and similar pathogenesis. We do not have data on the overall prevalence of these diseases in the general population, but if a projection of the incidence of aortic pathology in the Republic of Croatia was made from an European perspective, the need for surgical procedures would be estimated to be much higher. (2) However, observed trends are encouraging and require further monitoring, as well as encouragement to achieve optimum results regarding better prognosis quoad vitam and quoad valetudinem in patients undergoing surgical procedures in comparison to those who do not undergo surgery. (3, 4) Figure 1. The ratio of cardiac surgery procedures on the aortic valve and the total number of cardiac surgery procedures in the Republic of Croatia in 2014. Comorbidity of aortic stenosis and coronary heart disease is high, as our results over the last year indicate. The percentage of combined surgeries with aortic valve replacement (AVR) and aortocoronary bypass implantation (ACBP) was 31%, and the percentage of isolated aortic valve replacement procedures was 69% (Figure 2). The prevalence of combined aortic valve procedures is still somewhat lower in comparison with data from some European registries. Coexistence of aortic disease and coronary heart disease can be up to 37% in severe aortic stenosis cases, and even higher in moderate and mild aortic stenosis. We do not have any data on these relationships in our population. Figure 2. The ratio of isolated and combined aortic valve replacements (AVR) with aortocoronary bypass (ACBP) and other valves in 2014 in the Republic of Croatia. AVR = aortic valve replacement; ACBP = aortocoronary bypass The types of surgical procedures performed in 2014 in Croatia are shown in Figure 3. Aortic valve replacement, using either mechanical or bioprosthetic valves, is the most common. Mechanical valves are slightly more common than bioprosthetic valves. Aortic valve repair is also present in small numbers (3%). Aortic valve repair is still reserved for aortic regurgitation, which has a lower prevalence (Figure 4). The other reason for the small number of aortic valve repair procedures is the complexity of the procedure. With the standardization of two techniques (the David Tirone procedure and Yacoubu procedure, i.e. its modification by Emmanuel Lansac) we can expect an increase in aortic repair instead of replacement. Implantation of composite grafts in the ascending aorta accounted for 10% of all aortic valve surgeries. There were relatively few transcatheter aortic valve implantation (TAVI) procedures in comparison with other procedures. Figure 3. Types of aortic valve surgical procedures in 2014 in the Republic of Croatia. TAVI = Transcatheter Aortic Valve Implantation Figure 4. Reasons for aortic valve surgical procedures in 2014 in the Republic of Croatia. AS = aortic stenosis; AR = aortic regurgitation ## Transcatheter aortic valve implantation It has been three years since the first transcatheter aortic valve implantation in Croatia, and we wrote more extensively about this procedure in a previous editorial in 2012. (1) The number of centers that have tried their hand at this new treatment technique for severe aortic stenosis has since grown to four, but the number of individual implantations in each center is very low, and is sometimes below five. Although the number of TAVI procedures indicates a significant upward trend in comparison with previous years, we are still in the learning phase since only 29 TAVI procedures have been performed in 2014. These data should definitely be taken to indicate that Croatian centers strive to follow the global trend of rapidly increasing preference for these interventions as a replacement for surgical procedures. This trend is best illustrated by results from AQUA Institute GmbH in 2009 and 2012, according to which 10 285 surgical procedures and 2565 TAVI procedures were performed in Germany in 2009, whereas three years later, in 2012, the ratio of TAVI to surgical procedures has become almost one-to-one, with 9929 surgical aortic valve replacements compared with 9341 TAVI procedures. (5, 6) The main limiting factor in caring for inoperable patients with severe aortic stenosis is the economic situation. It will certainly be necessary to come up with modalities that will allow us to reach the treatment standard provided by cutting-edge medical treatment elsewhere in the world. The endovascular, i.e. transfemoral approach is dominant in comparison with the transapical approach (Figure 5), significantly so (83% transfemoral compared with 17% transapical). Individual reports indicate an acceptable likelihood of complications and mortality. Figure 5. Transcatheter aortic valve implantation (TAVI) procedures with regard to the type of the approach in the Republic of Croatia in 2014.

    Literature

    1. Mirat J, Ćorić V, Bernat R, Vrbanić L, Vrljić D, Vojković J, et al. Valvular heart diseases in Croatia in 2011. Cardiol Croat. 2012;7(3-4):59–64.
    2. Mirat J, Ćorić V, et al. Bolesti srčanih zalistaka. Zagreb: Nakladni zavod Globus; 2011.
    3. Lund O, Nielsen TT, Emmertsen K, Fio C, Rasmussen B, Jensen FT, et al. Mortality and worsening of prognostic profile during waiting time for valve replacement in aortic stenosis. Thorac Cardiovasc Surg. 1996;44:289–95. https://doi.org/10.1055/s-2007-1012039
    4. Kvidal P, Bergström R, Hörte LG, Stahle E. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000;35:747–56. https://doi.org/10.1016/S0735-1097(99)00584-7
    5. Institute for Applied Quality Improvement and Research in Health Care GmbH. German Hospital Quality Report 2012. (7.6.2015). http://www.sqg.de/sqg/upload/CONTENT/EN/Quality-Report/AQUA-German-Hospital-Quality-Report-2012.pdf
    6. Institute for Applied Quality Improvement and Research in Health Care GmbH. German Hospital Quality Report 2012. German Hospital Quality Report 2009. (7.6.2015). http://www.sqg.de/sqg/upload/CONTENT/EN/Quality-Report/AQUA-German-Hospital-Quality-Report-2009.pdf
    Cardiologia Croatica
    Back to search

    Aortic Valve Diseases in Croatia in 2014 and Their Treatment

    Editorial
    Issue5-6
    Published
    Pages126-128
    PDF via DOIhttps://doi.org/10.15836/ccar.2015.126

    Authors

    Jure Mirat*ORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Igor AlfirevićORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Stjepan BarišinORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Robert BernatORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Bojan BiočinaORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Vedran ĆorićORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Igor MedvedORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Krunoslav ŠegoORCIDWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Daniel UnićWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia
    Jakov VojkovićWorking Group on Valvular Heart Disease, Croatian Cardiac Society, Croatia

    *Correspondence email: jure_mirat@yahoo.com

    Full Text

    Surgical treatment of aortic valve disease in the Republic of Croatia is a surgical procedure that has a very important place in the overall operating procedures in cardiac surgery centers. According to the reports of all six cardiac surgery centers, aortic valve procedures make up 23% of total procedures performed, which in absolute numbers means 636 aortic valve surgeries in 2014 (Figure 1). In comparison with data from 2012 (1), there has been an increase in the number of aortic valve procedures of about 8% during the last three years. This is in line with the needs based on the incidence of the disease, especially coronary pathology that stands side to side with coronary pathology with which it shares risk factors and similar pathogenesis. We do not have data on the overall prevalence of these diseases in the general population, but if a projection of the incidence of aortic pathology in the Republic of Croatia was made from an European perspective, the need for surgical procedures would be estimated to be much higher. (2) However, observed trends are encouraging and require further monitoring, as well as encouragement to achieve optimum results regarding better prognosis quoad vitam and quoad valetudinem in patients undergoing surgical procedures in comparison to those who do not undergo surgery. (3, 4)

    Figure 1. The ratio of cardiac surgery procedures on the aortic valve and the total number of cardiac surgery procedures in the Republic of Croatia in 2014.

    Comorbidity of aortic stenosis and coronary heart disease is high, as our results over the last year indicate. The percentage of combined surgeries with aortic valve replacement (AVR) and aortocoronary bypass implantation (ACBP) was 31%, and the percentage of isolated aortic valve replacement procedures was 69% (Figure 2). The prevalence of combined aortic valve procedures is still somewhat lower in comparison with data from some European registries. Coexistence of aortic disease and coronary heart disease can be up to 37% in severe aortic stenosis cases, and even higher in moderate and mild aortic stenosis. We do not have any data on these relationships in our population.

    Figure 2. The ratio of isolated and combined aortic valve replacements (AVR) with aortocoronary bypass (ACBP) and other valves in 2014 in the Republic of Croatia. AVR = aortic valve replacement; ACBP = aortocoronary bypass

    The types of surgical procedures performed in 2014 in Croatia are shown in Figure 3. Aortic valve replacement, using either mechanical or bioprosthetic valves, is the most common. Mechanical valves are slightly more common than bioprosthetic valves. Aortic valve repair is also present in small numbers (3%). Aortic valve repair is still reserved for aortic regurgitation, which has a lower prevalence (Figure 4). The other reason for the small number of aortic valve repair procedures is the complexity of the procedure. With the standardization of two techniques (the David Tirone procedure and Yacoubu procedure, i.e. its modification by Emmanuel Lansac) we can expect an increase in aortic repair instead of replacement. Implantation of composite grafts in the ascending aorta accounted for 10% of all aortic valve surgeries. There were relatively few transcatheter aortic valve implantation (TAVI) procedures in comparison with other procedures.

    Figure 3. Types of aortic valve surgical procedures in 2014 in the Republic of Croatia. TAVI = Transcatheter Aortic Valve Implantation

    Figure 4. Reasons for aortic valve surgical procedures in 2014 in the Republic of Croatia. AS = aortic stenosis; AR = aortic regurgitation

    Transcatheter aortic valve implantation

    It has been three years since the first transcatheter aortic valve implantation in Croatia, and we wrote more extensively about this procedure in a previous editorial in 2012. (1) The number of centers that have tried their hand at this new treatment technique for severe aortic stenosis has since grown to four, but the number of individual implantations in each center is very low, and is sometimes below five. Although the number of TAVI procedures indicates a significant upward trend in comparison with previous years, we are still in the learning phase since only 29 TAVI procedures have been performed in 2014.

    These data should definitely be taken to indicate that Croatian centers strive to follow the global trend of rapidly increasing preference for these interventions as a replacement for surgical procedures. This trend is best illustrated by results from AQUA Institute GmbH in 2009 and 2012, according to which 10 285 surgical procedures and 2565 TAVI procedures were performed in Germany in 2009, whereas three years later, in 2012, the ratio of TAVI to surgical procedures has become almost one-to-one, with 9929 surgical aortic valve replacements compared with 9341 TAVI procedures. (5, 6) The main limiting factor in caring for inoperable patients with severe aortic stenosis is the economic situation. It will certainly be necessary to come up with modalities that will allow us to reach the treatment standard provided by cutting-edge medical treatment elsewhere in the world. The endovascular, i.e. transfemoral approach is dominant in comparison with the transapical approach (Figure 5), significantly so (83% transfemoral compared with 17% transapical). Individual reports indicate an acceptable likelihood of complications and mortality.

    Figure 5. Transcatheter aortic valve implantation (TAVI) procedures with regard to the type of the approach in the Republic of Croatia in 2014.

    Literature

    1. 1.
      Mirat J, Ćorić V, Bernat R, Vrbanić L, Vrljić D, Vojković J, et al. Valvular heart diseases in Croatia in 2011. Cardiol Croat. 2012;7(3-4):59–64.
    2. 2.
      Mirat J, Ćorić V, et al. Bolesti srčanih zalistaka. Zagreb: Nakladni zavod Globus; 2011.
    3. 3.
      Lund O, Nielsen TT, Emmertsen K, Fio C, Rasmussen B, Jensen FT, et al. Mortality and worsening of prognostic profile during waiting time for valve replacement in aortic stenosis. Thorac Cardiovasc Surg. 1996;44:289–95.DOI
    4. 4.
      Kvidal P, Bergström R, Hörte LG, Stahle E. Observed and relative survival after aortic valve replacement. J Am Coll Cardiol. 2000;35:747–56.DOI
    5. 5.
      Institute for Applied Quality Improvement and Research in Health Care GmbH. German Hospital Quality Report 2012. (7.6.2015).Link
    6. 6.
      Institute for Applied Quality Improvement and Research in Health Care GmbH. German Hospital Quality Report 2012. German Hospital Quality Report 2009. (7.6.2015).Link