Heart surgery in Norway 2006 Norwegian Association of by wvd19763

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									             Heart surgery in Norway 2006
             Norwegian Association of Cardiothoracic
                           Surgeons

                   Jan L.Svennevig, MD,PhD
                         j.l.svennevig@medisin.uio.no




16.10.2007                                              1
Heart surgery in Norway 2006
                        All operations

6000
                                                      5147 5400 5299 5230
                                          4979 5074
5000
                   4416 4602 4457 4448
       4008 4135
4000

3000

2000

1000

   0
       1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006


 Incl. open and closed heart surgery and surgery on the thoracic aorta.     2
 ICD and pacemakers are not included
Heart surgery in Norway 2006
                    Heart lung machines

6000
                                                          5163 5090 5079
                                                   4864
5000                                     4694 4745
                   4259 4381 4316 4263
       3874 3967
4000

3000

2000

1000

   0
       1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006


                                                                           3
         Heart surgery in Norway
      No. of operations per 100.000 inh.
                                                                                                                                                           202
200
                                                                                                                                                   172

                                                                                                                                        150
150          136                                                  135
      127                  122                             122              123
                                           121                                                   120                120                                              2004
                                  102             105                               101 98
                                                                                                             91                  95                                  2005
100
                     76                                                                                                                                              2006

50


  0
      Oppl

             Hedm

                    Oslo

                           Østf

                                  Akersh

                                           Busk

                                                  Vestf

                                                          Telem

                                                                  Aust-A

                                                                           Vest-A

                                                                                    Rog

                                                                                          Hord

                                                                                                 Sogn&F

                                                                                                          Møre&R

                                                                                                                   Sørt-Tr

                                                                                                                             Nord_tr

                                                                                                                                       Nordland

                                                                                                                                                  Troms

                                                                                                                                                          Finnmark
                                                                                                                                                                            4
  HEART SURGERY IN NORWAY
                 No. of operations /Hospital


1400
1200             1107                     1100
1000
                                                        2004
 800                    626         637           662
           522                576                       2005
 600
                                                        2006
 400
 200
   0
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                                                          5
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      HEART SURGERY IN NORWAY
            Coronary artery bypass surgery
No.
4000
3500           3222 3207 3104      3299 3386 3362 3430 3258
                              3021                          3123
3000 2883 2945

2500
2000
1500
1000
500
      0
          1995

                 1996

                        1997

                               1998

                                      1999

                                             2000

                                                    2001

                                                           2002

                                                                  2003

                                                                         2004

                                                                                2005

                                                                                       2006
                                                                                              6
      HEART SURGERY IN NORWAY
                               Valve surgery
No.
1600
                                                                                 1408 1446
1400                                                                      1294
1200                                                 1129 1175 1193
1000                            838           898
                                       830
800       645    651    687
600
400
200
      0
          1995

                 1996

                        1997

                                1998

                                       1999

                                              2000

                                                     2001

                                                            2002

                                                                   2003

                                                                          2004

                                                                                 2005

                                                                                        2006
                                                                                               7
      HEART SURGERY IN NORWAY
                    Congenital (<18 Y)
No.

500
450
400          362           374    367                                378           362
      349           354                  356    343                         355
350                                                    330    334
300
250
200
150
100
 50
  0
      1995

             1996

                    1997

                           1998

                                  1999

                                         2000

                                                2001

                                                       2002

                                                              2003

                                                                     2004

                                                                            2005

                                                                                   2006
                                                                                          8
      HEART SURGERY IN NORWAY
             Thoracic aorta excl. valves
No.

200
180                                                                                172
                                                                     161    154
160                                                           151
140                                                    133
                                                116
120
100                               80     81
             75            78
 80                 63
 60   50
 40
 20
  0
      1995

             1996

                    1997

                           1998

                                  1999

                                         2000

                                                2001

                                                       2002

                                                              2003

                                                                     2004

                                                                            2005

                                                                                   2006
                                                                                          9
      HEART SURGERY IN NORWAY
                    Thoracic transplants
No.

100
 90
 80
 70                                                           65
 60                                                                                57
                                                                            48
 50                        44     44            43                   44
      37            37                   40            39
 40
             29
 30
 20
 10
  0
      1995

             1996

                    1997

                           1998

                                  1999

                                         2000

                                                2001

                                                       2002

                                                              2003

                                                                     2004

                                                                            2005

                                                                                   2006
                                                                                      10
 Elective and emergency surgery
• Elective         n=   4015
• Emergency        n=   1215 (23.2%)



• Female gende     n=   1422 (27.2%)
• Redo operation   n=    335 ( 6.5%)

                                       11
 Interventional coronary treatment in Norway vs CABG
No of patients
 14000
                                                                                        11703
 12000                                                                          11269

                                                                         9892
 10000
                                                                 7649
  8000                                                   7381                                            PCI
                                                 5511
                                                                                                         CABG
  6000                                   5170
                          4026 4200
  4000     3230
             2882
                    3500
                      2945 3222 3207      3104    3021    3299    3386    3362    3430    3258    3122


  2000
       0
            1995
                    1996
                           1997
                                  1998
                                         1999
                                                 2000
                                                         2001
                                                                 2002
                                                                         2003
                                                                                 2004
                                                                                         2005
                                                                                                 2006
             Source: The Norwegian Association of Cardiothoracic surg.                                   12
        HEART SURGERY IN NORWAY 2006
                            AGE DISTRIBUTION
No. of patients
1800                                                     1599
1600                                              1515

1400
1200
                                            937                        2000
1000
                                                                       2003
 800
                                                                       2006
 600
                                                                 430
 400       279                        250
 200                64    49
                                107

    0
         0-9      10-19 20-29 30-39 40-49 50-59 60-69 70-79     80-
                         AGE GROUPS                                    13
       HEART SURGERY IN NORWAY
MEAN AGE AND OLDEST PATIENT, ADULTS (>18 YEARS)

Yrs.
                                           1995
100
                                     90    1996
 90
                                           1997
 80
                    65.7                   1998
 70
                                           1999
 60
                                           2000
 50
                                           2001
 40
                                           2002
 30
                                           2003
 20
                                           2004
 10
                                           2005
  0
                                           2006
                                             14
         MEAN AGE           OLDEST
     Valve operations 2003-2006
• Aortic valve surgery    992 1099 1179 1206
• Mitral valve surgery    202 209 261 262

• Mechanical prostheses   608   573 521   482
• Biological prostheses   428   569 746   828
• Valve plasties          105   125 171   177



                                            15
Mechanical vs. Bioprostheses, trends 1995-2006

%
 90
        80                                  1995
 80
                                            1996
 70                                    63   1997
 60                                         1998
 50                                         1999
                     37                     2000
 40
                                            2001
 30                                         2002
                          20
 20                                         2003
 10                                         2004
                                            2005
    0
                                            2006
             Mech.             Biol.

                                                   16
    Heart operations in Norway 2006
          Preop.risk factors(%)
%
     20
     18
     16                                                                  2000
     14                                                                  2001
                12
     12                                                                  2002
     10                                                                  2003
      8                                                                  2004
                            5.6                                    5.3   2005
      6
      4                                                                  2006
                                                         2
     2                                   1
     0
          Diabetes   Stroke/Tia Endocarditis    Renal        Euroscore
                                               failure
                                                                          17
    Heart operations in Norway 2006
          30-day mortality (%)
%
      20
      18
      16
                                                                                              2001
      14
                                                                                              2002
      12
                                                                                              2003
      10
                                                                                              2004
       8                                      6.7
                                                           5.8                  5.3           2005
       6
                                     3.9
       4                   2.7
                                                                                              2006
                                                                                        2.5
                1.3                                                  1.7
       2
       0




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                                                                                               18
    Heart operations in Norway 2006
             Morbidity (%)
%
     20
     18                                                                                    2000
     16                                                                                    2001
     14                                                                                    2002
     12                                                                                    2003
     10                                                                                    2004
      8                                                                                    2005
      6             4.4                                         3.9                        2006
      4                   2.6         1.8
                                1.5               1.2                                1.2
      2                                                                  0.6
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