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Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
Regional differences in aortic valve replacements: Atlantic Canadian experience
Connor McGuire1, Alexandra M Yip1, Jeffrey B MacLeod1
1From the departments of Medicine and Surgery, Dalhousie University, Halifax, NS (McGuire, Nadeem, Hirsch); Dalhousie Medicine New Brunswick, Saint John, NB (Paddock, Lutchmedial, Hassan, Légaré); Cardiovascular Research New Brunswick, New Brunswick Heart Centre, Saint John Regional Hospital, Saint John, NB (Yip, MacLeod, Paddock, Lutchmedial, Hassan, Légaré); and the Memorial University of Newfoundland, St. John's, NL (Adams, Melvin).
Regional variations exist in aortic valve disease treatment across Atlantic Canada, with differing rates of transcatheter aortic valve implantation (TAVI) and valve types used. Further research is needed to understand these differences in surgical aortic valve replacement (SAVR) and TAVI.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Device Technology
Background:
- Transcatheter aortic valve implantation (TAVI) is a rapidly advancing treatment for aortic valve disease.
- Surgical aortic valve replacement (SAVR) is the traditional treatment for aortic valve disease.
Purpose of the Study:
- To investigate regional disparities in the utilization of SAVR and TAVI across Atlantic Canada.
- To compare patient demographics and procedural outcomes between different regions.
Main Methods:
- Retrospective analysis of 3042 patients undergoing SAVR or TAVI between 2010 and 2014 in New Brunswick, Nova Scotia, and Newfoundland and Labrador.
- Calculation of crude and age-/sex-adjusted incidence rates for aortic valve replacement (AVR) procedures.
- Comparison of valve type selection (mechanical vs. bioprosthetic) across regions.
Main Results:
- Significant regional differences were observed in valve type selection, with Newfoundland and Labrador favoring mechanical valves.
- Transcatheter aortic valve implantation (TAVI) rates increased over the study period, with earlier adoption in New Brunswick.
- Adjusted rates of all aortic valve replacement (AVR) procedures were highest in Nova Scotia and showed slower growth in New Brunswick and Newfoundland and Labrador.
Conclusions:
- Despite similar patient demographics, significant regional variations in aortic valve disease management exist within Atlantic Canada.
- Differences in AVR rates may be attributed to geographical factors, practice variations, or access to care.
- Further investigation is warranted to elucidate the drivers behind these observed regional disparities.
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