Minimally invasive heart treatments have reduced bypass surgeries and influenced valve repair and replacement
Research Activities October 2011, No. 374
Changes in the treatment of coronary artery blockages have, in turn, influenced the rates and timing of valve replacement and repair, according to a study of Medicare patients. The use of minimally invasive percutaneous coronary interventions (PCIs), including coronary angiography with angioplasty and stent placement, have become a credible alternative to coronary artery bypass grafting (CABG), the researchers note. Between 1991 and 2005, enrollees in Medicare fee-for-service (FFS) plans had 3.6 million PCIs, 2.5 million CABGs, 582,000 valve replacements, and 62,000 valve repairs. The number of CABGs peaked in 1996 after increasing 36 percent from 1991, only to drop 30 percent from the peak volume by 2005. PCIs increased steadily, by 148 percent, over the entire study period.
During the initial period (1991-1996), valve placement and repair volumes increased by 34 percent and 23 percent, respectively. Subsequently (from 1996-2005), valve replacement and repair volume grew by 11 percent and 243 percent, respectively. One possibility for the inverse relationship between CABG volume and isolated valve repair is that cardiothoracic surgeons who perform fewer CABGs may have more time available to repair valves, the researchers note. However, the study did not have the clinical data to determine whether the increase in valve repairs is meeting a real clinical need or giving more patients access to valve surgery who might be treated with less expensive and invasive techniques, the researchers conclude. They used Medicare Provider and Analysis Review Part A data files to identify all Medicare FFS enrollees who underwent PCI, CABG, and heart valve repair or replacement during the period under study.
The study was funded in part by the Agency for Healthcare Research and Quality (HS16964) to the Duke University Center for Education and Research in Therapeutics (CERT). For more information on the CERTs program, visit Centers for Education & Research on Therapeutics (CERTs) .
More details are in "Shifts in surgical revascularization and valve procedures among Medicare beneficiaries," by Jason Hockenberry, Ph.D., Xin Lu, M.S., Mary S. Vaughan-Sarrazin, Ph.D., and others, in the August 2011 Medical Care 49(8), pp. 686-692.