Aim: Review of changing patterns in a cardiac surgical practice can help to guide the long-term strategy options in a setting of changing population demographics, evolving technology, and environmental shifts.
Methods: Review of all 14 673 adult cardiac operations from 1991 until 2005.
Results: CABG peaked in 1995 (n=719) and declined with 52% in 2005 (n=348). Early mortality remained stable despite the increase of age, risk profile and previous percutaneous interventions. There was no major rise in late redo CABG. Multiple arterial revascularization increase with Off-pump and minimally invasive CABG increased up to 38% in 2005. Valve surgery volume increased from 1997 up to 2005 with 200%, from 174 to 373 cases annually. Limited access surgery accounted for 66% of all the valve procedures in 2005. There is an increase of mitral valve repair with 500% and declining use of mechanical prosthesis.
Combined Valve and CABG surgery increased with 300% over the last 10 years, from 52 cases in 1991 up to 164 cases in 2005, with a small decline in 2004 and 2005 due to the changing trends of hybrid therapy. Concomitant Atrial Fibrillation surgery increased from 4 (1999) to 149 procedures in 2005.
Conclusion: CABG volumes are decreasing continuously with an increasing use of multiple arterial grafting and less invasive procedures. Valve operation volumes are steadily increasing, with an important shift tot minimal access surgery, valve repair and tissue valves. Combined procedures increase significantly with hybrid therapy as an alternative in the recent years. Long-term planning in infrastructure, manpower, pathology and patient referral strategy will be influenced by these changing trends.
Changing trends in Cardiac Surgery in a multisurgeon group 1991 - 2005Wellens F ., De Geest R., Degrieck I., Van Praet F., Casselman F., Vermeulen Y., Vanermen H.
OLV Clinic, Aalst |