IntroductionBased on European guidelines, transcatheter aortic valve implementation (TAVI) could be the therapy of choice in patients with severe aortic stenosis aged >= 75 years. In the... Show moreIntroductionBased on European guidelines, transcatheter aortic valve implementation (TAVI) could be the therapy of choice in patients with severe aortic stenosis aged >= 75 years. In the Netherlands, there has been a debate between healthcare providers and the National Health Care Institute regarding reimbursement for TAVI, which resulted in an indication document that defines TAVI patients who are eligible for reimbursement. This document has been effective since 1 January 2021.MethodsWe extracted data from the Netherlands Heart Registry for patients who underwent biological surgical aortic valve replacement (SAVR) or TAVI in the Netherlands from 2018 through 2021. We compared baseline characteristics and variables from the indication document for the subsequent years and age groups. We also analysed the annual SAVR/TAVI ratio.ResultsThe total number of patients treated with SAVR or TAVI was constant in 2018-2021. Baseline characteristics of patients treated with TAVI did not differ throughout the years. The SAVR/TAVI ratio shifted towards a higher percentage of TAVI from 2018 to 2019. From 2019 to 2020, the TAVI percentage was constant. Since the implementation of the indication document (in 2021), a change in the SAVR/TAVI ratio was not found either.ConclusionSince the implementation of the national indication document for AVR in 2021, no major effect was seen for the SAVR versus TAVI landscape in the Netherlands. Show less
This thesis focuses on more than 30 years__ experience of surgical correction of various types of AVSD in Leiden University Medical Center, Leiden. AVSD repair can be accomplished with good long... Show moreThis thesis focuses on more than 30 years__ experience of surgical correction of various types of AVSD in Leiden University Medical Center, Leiden. AVSD repair can be accomplished with good long-term results. Risk factors for early mortality were surgical era before 1996 and younger age at surgery. Risk factors for late reoperation were associated cardiovascular anomalies, left atrioventricular valve dysplasia, and absence of cleft closure. There was a strong decline in age at AVSD repair in the last decade, and at the same time a significant decrease in in-hospital mortality. The estimated overall survival of patients with a reoperation for LAVVR is good and comparable to that of patients not reoperated for LAVVR after AVSD repair. Yet, survival after left atrioventricular valve repair was higher than after left atrioventricular valve replacement. AVSD with DO-LAVV can be repaired with low mortality,but it is a risk factor for reoperation. A transatrial-transpulmonary approach can be used for c-AVSD-TOF repair without cardiac related mortality, limited reoperation rates and good functional outcomes in all surviviors. Artificial chordae form a useful addition to the surgical armamentarium for mitral and tricuspid valve repair in case of different anomalies of chordae tendinae Show less
Background. Outcome of surgical correction of atrioventricular septal defects (AVSD) still varies despite enhanced results. We reviewed our 30-year experience with AVSD repair and identified risk... Show moreBackground. Outcome of surgical correction of atrioventricular septal defects (AVSD) still varies despite enhanced results. We reviewed our 30-year experience with AVSD repair and identified risk factors for mortality and reoperation. Methods. Between 1975 and 2006, 312 patients underwent surgery for complete AVSD (n = 209; 67.0%), partial AVSD (n = 76; 24.4%), or intermediate AVSD (n = 27; 8.6%). Mean age was 2.4 +/- 3.9 years; 142 patients (45.5%) were younger than 6 months. Follow-up was 99.0% complete. Results. There were 26 in-hospital deaths (8.3%) and 6 late deaths (2.1% of 283). Estimated overall survival for the total study population was 91.3%, 90.6%, and 88.6% at 1, 5, and 15 years, respectively. In the multivariable logistic regression analysis, surgical era 1975 to 1995 (p < 0.001) and younger age (p = 0.004) were found to be independent risk factors for early mortality, whereas preoperative AV valve insufficiency showed a tendency toward statistical significance (p = 0.052). Of the hospital survivors, 43 patients required a late reoperation. Estimated freedom from late reoperation was 96.4%, 89.3%, and 81.8% at 1, 5, and 15 years, respectively. Multivariable Cox regression analysis showed associated cardiovascular anomalies (p < 0.001), left AV valve dysplasia (p < 0.001), and absence of cleft closure (p = 0.003) to be independent risk factors for late reoperation. Conclusions. AVSD repair can be accomplished with good long-term results. Early surgical era, associated cardiovascular anomalies, left AV valve dysplasia, and absence of cleft closure negatively influence survival and risk of reoperation. (Ann Thorac Surg 2010;90:1554-62) (C) 2010 by The Society of Thoracic Surgeons Show less
