TY - JOUR
T1 - Perioperative care differences of surgical aortic valve replacement between North America and Europe
AU - Velders, Bart J.J.
AU - Vriesendorp, Michiel D.
AU - De Lind Van Wijngaarden, Rob A.F.
AU - Rao, Vivek
AU - Reardon, Michael J.
AU - Shrestha, Malakh
AU - Chu, Michael W.A.
AU - Sabik, Joseph F.
AU - Liu, Fang
AU - Klautz, Robert J.M.
N1 - Funding Information:
BJJV: institutional research grant and speaker’s honorarium paid to his department by Medtronic. MDV: institutional research grant and reimbursement of travel expenses from Medtronic. VR: consultant to Medtronic, Gore and Abbott; advisory board, Medtronic. MJR: consultant to Medtronic, Abbott Medical, Boston Scientific, Gore Medical and Transverse Medical; fees paid to department. MWAC: speaker’s honoraria from Medtronic, Edwards Lifesciences, Terumo Aortic, Abbott Vascular and Cryolife. JFS: North American Principal Investigator of the PERIGON Pivotal Trial for Medtronic. FL: employee of Medtronic. RJMK: research support, consultation fees, and European Principal Investigator of the PERIGON Pivotal Trial for Medtronic.
Publisher Copyright:
© 2023 BMJ Publishing Group. All rights reserved.
PY - 2023/6/26
Y1 - 2023/6/26
N2 - Objective To describe differences between North America and Europe in the perioperative management of patients undergoing surgical aortic valve replacement (SAVR). Methods Patients with moderate or greater aortic stenosis or regurgitation requiring SAVR were enrolled in a prospective observational cohort evaluating the safety and efficacy of a new stented bioprosthesis at 25 centres in North America (Canada and the USA) and 13 centres in Europe (Germany, the Netherlands, France, the UK, Switzerland and Italy). While all patients underwent implantation with the same bioprosthetic model, perioperative management was left to the discretion of participating centres. Perioperative care was described in detail including outcomes up to 1-year follow-up. Results Among 1118 patients, 643 (58%) were implanted in North America, and 475 (42%) were implanted in Europe. Patients in Europe were older, had a lower body mass index, less bicuspid disease and worse degree of aortic stenosis at baseline. In Europe, anticoagulant therapy at discharge was more aggressive, whereas length of stay was longer, and discharges directly to home were less common. Rehospitalisation risk was lower in Europe at 30 days (8.5% vs 15.9%) but converged at 1-year follow-up (26.5% vs 28.1%). Within continents, there were major differences between individual countries concerning perioperative management. Conclusion Contemporary perioperative management of SAVR patients varies between North America and Europe in patient selection, procedural techniques, antithrombotic regimen and discharge management. Furthermore, rehospitalisation differed largely between continents and countries. Hence, geographical setting must be considered during design and interpretation of trials on SAVR. Trial registration number NCT02088554.
AB - Objective To describe differences between North America and Europe in the perioperative management of patients undergoing surgical aortic valve replacement (SAVR). Methods Patients with moderate or greater aortic stenosis or regurgitation requiring SAVR were enrolled in a prospective observational cohort evaluating the safety and efficacy of a new stented bioprosthesis at 25 centres in North America (Canada and the USA) and 13 centres in Europe (Germany, the Netherlands, France, the UK, Switzerland and Italy). While all patients underwent implantation with the same bioprosthetic model, perioperative management was left to the discretion of participating centres. Perioperative care was described in detail including outcomes up to 1-year follow-up. Results Among 1118 patients, 643 (58%) were implanted in North America, and 475 (42%) were implanted in Europe. Patients in Europe were older, had a lower body mass index, less bicuspid disease and worse degree of aortic stenosis at baseline. In Europe, anticoagulant therapy at discharge was more aggressive, whereas length of stay was longer, and discharges directly to home were less common. Rehospitalisation risk was lower in Europe at 30 days (8.5% vs 15.9%) but converged at 1-year follow-up (26.5% vs 28.1%). Within continents, there were major differences between individual countries concerning perioperative management. Conclusion Contemporary perioperative management of SAVR patients varies between North America and Europe in patient selection, procedural techniques, antithrombotic regimen and discharge management. Furthermore, rehospitalisation differed largely between continents and countries. Hence, geographical setting must be considered during design and interpretation of trials on SAVR. Trial registration number NCT02088554.
KW - aortic valve insufficiency
KW - aortic valve stenosis
KW - health care economics and organizations
KW - heart valve prosthesis implantation
KW - Perioperative Care
KW - Humans
KW - Risk Factors
KW - Treatment Outcome
KW - Heart Valve Prosthesis/adverse effects
KW - Transcatheter Aortic Valve Replacement/methods
KW - Heart Valve Prosthesis Implantation/adverse effects
KW - Europe/epidemiology
KW - Aortic Valve Stenosis/surgery
KW - Aortic Valve/surgery
KW - North America/epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85152389839&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85152389839&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2023-322350
DO - 10.1136/heartjnl-2023-322350
M3 - Article
C2 - 36963820
AN - SCOPUS:85152389839
VL - 109
SP - 1106
EP - 1112
JO - Heart
JF - Heart
SN - 1355-6037
IS - 14
ER -