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Opposite trends in coronary artery and valve surgery in a large multisurgeon practice, 1979-1999
William F Northrup1, Robert W Emery, Demetre M Nicoloff
1Cardiac Surgical Associates, P.A., St. Paul, Minnesota, USA. north7@earthlink.net
Insights
Coronary artery bypass surgery volumes are declining, while valve operations are increasing. Cardiac surgery trends show shifts towards left internal mammary artery grafts and off-pump procedures for bypass, and tissue valves for operations.
Area of Science:
- Cardiovascular Surgery
- Surgical Trends
- Cardiac Procedure Analysis
Background:
- Analyzing trends in coronary artery bypass (CAB) and valve operations (VO) is crucial for predicting the future of cardiac surgery.
- Factors influencing these trends include changing case mix, evolving paradigms, new technologies, and demographic shifts.
Purpose of the Study:
- To retrospectively review adult CAB and VO data to identify significant trends.
- To understand shifts in patient demographics, procedural techniques, and outcomes over a 20-year period.
Main Methods:
- Retrospective review of 30,319 adult CAB and VO procedures performed between 1979 and 1999.
- Analysis of procedural volumes, patient risk profiles, demographics, graft usage, and technology adoption.
Main Results:
- Coronary artery bypass (CAB) volumes peaked in 1996 and subsequently declined, with increased use of left internal mammary artery (LIMA) grafts and off-pump techniques.
- Valve operation (VO) volumes steadily increased, with a shift from mechanical valves to tissue solutions.
- Patient populations for both procedures showed increased mean age, higher rates of octogenarians, and more prior percutaneous coronary interventions (PCI).
Conclusions:
- Coronary artery bypass surgery is experiencing a decline in volume, marked by increased LIMA graft utilization and a rise in off-pump procedures.
- Valve operation volumes are consistently growing, with a notable decrease in mechanical valve implants favoring tissue-based solutions.
Background:
Trends in coronary artery bypass (CAB) and valve operations (VO) may help predict the future of cardiac surgery in the context of changing case mix, shifting paradigms, emerging technology, and population demographics.
Methods:
We retrospectively reviewed all 30,319 adult CAB and VO in our group from 1979 to 1999 according to specific procedures.
Results:
Coronary artery bypass volumes peaked in 1996 at 1,895 cases, declining 15.3% to 1,605 cases in 1999 with a decrease in risk profile and percent reoperations and an increase in mean age and percent octogenarians, prior percutaneous coronary interventions (PCI), left internal mammary artery (LIMA) graft usage, off-pump technology usage, and hospital mortality of reoperations. Right internal mammary grafts were employed infrequently and radial artery grafts transiently. Overall VO volumes continued to increase 24.0% since 1996, from 470 to 583 cases with a decreased risk profile, increased mean age, and percent octogenarians and prior PCI. The percentage of mechanical valve implants decreased, while the percentage of various tissue solutions for valve disease increased. Limited access incisions and port-access were employed transiently with CAB and VO.
Conclusions:
Coronary artery bypass volumes are decreasing, with an increasing percentage of LIMA grafts and off-pump cases. Valve operation volumes are steadily increasing, with a decreasing percentage of mechanical valve implants, in favor of various tissue solutions.
