Original article

Coronary and structural heart interventions in Switzerland 2018

DOI: https://doi.org/10.4414/smw.2020.20200
Publication Date: 07.04.2020
Swiss Med Wkly. 2020;150:w20200

Thomas Nestelbergera*, Raphael Twerenbolda*, Stéphane Cookb, Oliver Gaemperlic, Pascal Meierd, Olivier Muellere, Fabian Nietlispachf, Lorenz Räberg, Daniel Weilenmannh, Raban Jegera

a Cardiology, University Hospital Basel, University of Basel, Switzerland

b Cardiology, Cantonal Hospital Fribourg, Switzerland

c HeartClinic, Hirslanden Hospital Zurich, Switzerland

d Cardiology, Cantonal Hospital Chur, Switzerland

e Cardiology, University Hospital Lausanne, University of Lausanne, Switzerland

f HerzGefässZentrum, Hirslanden Klinik im Park, Zurich, Switzerland

g Cardiology, University Hospital Bern, University of Bern, Switzerland

h Cardiology, Cantonal Hospital St Gallen, Switzerland

Summary

Since the first coronary angioplasty by Andreas Grüntzig in Zurich in 1977, the number of cardiac interventional procedures has steadily increased. The aim of this report is to summarise the state of catheter-based cardiac interventions in adults in Switzerland in 2018. Since 1987, the Working Group Interventional Cardiology of the Swiss Society of Cardiology has collected annually aggregate data from all facilities with cardiac catheterisation laboratories in the country, currently 36 institutions in 17 cantons of Switzerland. Over past years, the numbers of coronary angiography procedures (CAs) and percutaneous coronary interventions (PCIs) increased steadily reaching 57,309 for CA and 27,318 for PCI in 2018. Among structural heart interventions, a broad spectrum of transcatheter procedures is currently available in Switzerland. Numbers of transcatheter aortic valve implantations similarly increased, with 1781 implantations in 2018.

Keywords: annual report, interventional cardiology, structural cardiology

Introduction

Cardiovascular diseases including coronary artery disease and structural heart disease are still the main causes of hospitalisations and medical consultations worldwide. Despite improvements in the management of patients with cardiovascular diseases, they remain life-threatening disorders [13]. In Switzerland, the entire population (permanent residents, periodic residents, as well as tourists) have an unrestricted access to emergency care and high-quality, evidence-based medicine, and health costs are covered by compulsory insurance. Individuals who cannot afford to pay health insurance fees are subsidised by the government.

In this scenario, the Working Group Interventional Cardiology of the Swiss Society of Cardiology performs a nationwide annual survey on percutaneous cardiac procedures in adults based on aggregate data provided by each institution. Since 1987, and based on a standardised questionnaire that has evolved over the years, all cardiology centres are asked to report yearly aggregate data on the number and type of procedures performed [4]. Since 2008, data have been published on the website of the Swiss Working Group for Interventional Cardiology of the Swiss Society of Cardiology and several publications emerged from these data [58].

Methods

All interventional centres in Switzerland were asked to participate and to fill in an online questionnaire or electronic data sheets containing important items that mirror current interventional activities. In our current version of the questionnaire, 71 items are covered: information on infrastructure, numbers of operators, availability of on-site cardiac surgery, numbers of coronary angiography investigations (CAs) and percutaneous coronary interventions (PCIs) (stratified for ST-segment elevation myocardial infarction [STEMI], non-ST-segment elevation acute coronary syndromes [NSTE-ACS], cardiogenic shock or cardiac arrest and stable coronary disease [CAD]), access site, specific revascularisation techniques (e.g., rotational atherectomy, recanalisation of chronic totally occluded vessels [CTO]), adjunctive techniques (e.g., use of intravascular imaging, distal protection devices) and use of mechanical circulatory support. Among structural heart interventions, information was available on balloon valvuloplasties, transcatheter aortic valve implantation (TAVI), percutaneous mitral-, tricuspidal- or pulmonary-valve interventions, closure of shunts, as well as of paravalvular leaks and left atrial appendage (LAA) occlusion, transcoronary ablation of septal hypertrophy (TASH), pericardial drainage, catheter-based therapies of pulmonary embolism, coronary sinus reduction, and interventional renal denervation. Finally, data on in-hospital mortality for PCIs were gathered and stratified according to the clinical presentation (STEMI, NSTE-ACS, stable CAD and cardiac arrest/cardiogenic shock).

Data were aggregated and displayed using standard software. There was no formal statistical analysis. Since data collection and analysis were for quality assurance/control purposes only for in-hospital mortality after interventional procedures, no formal approval by local institutional review boards and/or written patient consent is required.

Results

In 2018, there were 36 interventional centres located in 17 of the 26 Swiss cantons: 5 university hospitals, 15 non-university public hospitals and 16 private institutions. All 36 centres provided local data on their performances in 2018.

Coronary interventions

All centres performed both diagnostic and therapeutic procedures and 16 (43%) had on-site cardiac surgery (table 1). During 2018, 57,309 CAs and 27,318 PCIs were performed by 224 PCI operators and 37 operators performing diagnostic CA only (fig. 1). The median PCI/CA ratio was 47% with a range from 32 to 62% (table 2). Figure 1 displays the distribution of CA and PCIs among the different centres in 2018. The average number of CAs per operator was 220 cases/year and the average number of PCIs per operator was 122 cases/year (tables 1 and 2). With regard to access sites, the femoral and the radial artery were used almost equally often in all institutions together (53 vs 47%, respectively) with a wide range from 16 to 98% among the centres (table 3, fig. 2).

Table 1

Characteristics of the centres included.

CentreClinic descriptionCantonNumber of catheter labsPCI operatorsOperators diagnostic onlyCardiac surgery onsite
Aarau, Hirslanden KlinikNon-university community centreAargau214Yes
Aarau, KantonsspitalNon-university community centreAargau255No
Baden, KantonsspitalNon-university community centreAargau15No
Basel, St. ClaraspitalPrivate clinicBasel-Stadt13No
Basel, UniversitätsspitalUniversity centreBasel-Stadt281Yes
Bern, Klinik Beau-SitePrivate clinicBern27Yes
Bern, LindenhofspitalPrivate clinicBern243No
Bern, Universitätsspital und TiefenauUniversity centreBern411Yes
Biel, SpitalzentrumNon-university community centreBern15No
Brig, Centre de Cardiologie du ValaisPrivate clinicWallis13No
Chur, Kantonsspital GraubündenNon-university community centreGraubünden14No
Frauenfeld, Kantonsspital ThurgauNon-university community centreThurgau161No
Fribourg, Hôpital cantonalNon-university community centreFreiburg15No
Genf, Clinique des GrangettesPrivate clinicGenf143No
Genf, Hôpital de la TourPrivate clinicGenf283Yes
Genf, Hôpitaux universitairesUniversity centreGenf25Yes
Genolier, Clinique de GenolierPrivate clinicWaadt14No
Kreuzlingen, Herz-Neuro-Zentrum BodenseePrivate clinicThurgau17Yes
Lachen, SpitalNon-university community centreSchwyz161No
Lausanne, Centre hospitalier universitaire vaudoisUniversity centreWaadt26Yes
Lausanne, Clinique CecilPrivate clinicWaadt11711Yes
Lausanne, Clinique de la SourcePrivate clinicWaadt141No
Liestal, Kantonsspital BasellandNon-university community centreBasel-Landschaft12No
Lugano, Cardiocentro TicinoNon-university community centreTessin491Yes
Luzern, KantonsspitalNon-university community centreLuzern25Yes
Luzern, Klinik St. AnnaPrivate clinicLuzern151No
Morges, HôpitalNon-university community centreWaadt144No
Pfäffikon, Cardiance ClinicPrivate clinicSchwyz131No
Sion, Hôpital du ValaisNon-university community centreWallis25Yes
Solothurn, BürgerspitalNon-university community centreSolothurn14No
St. Gallen, KantonsspitalNon-university community centreSt. Gallen38No
Winterthur, KantonsspitalNon-university community centreZürich25No
Zürich, Hirslanden KlinikPrivate clinicZürich212Yes
Zürich, Klinik im ParkPrivate clinicZürich261Yes
Zürich, Triemli StadtspitalNon-university community centreZürich27Yes
Zürich, UniversitätsspitalUniversity centreZürich28Yes
Total17592243716

PCI = percutaneous coronary intervention

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Figure 1

Percutaneous coronary interventions (PCI) during the year 2018 in Switzerland. CA = coronary angiography

Table 2

Characteristics of the coronary interventions: number of cases and indications.

CentreTotal number of cases
(CA + PCI)
Diagnostic cases only
(CA only)
PCI% PCI per CAPCI for NST-ACSPCI for STEMIPCI for cardiogenic shock / cardiac arrestPCI for CTOAntegrade CTORetrograde CTO
Aarau, Hirslanden Klinik58237720535%321731515
Aarau, Kantonsspital2226124997744%3112382312911712
Baden, Kantonsspital55038416630%822121
Basel, St. Claraspital50030119940%258166
Basel, Universitätsspital24891281120849%2962729064568
Bern, Klinik Beau-Site158288469844%9246n.a.n.a.n.a.
Bern, Lindenhofspital139565574053%9264871010
Bern, Universitätsspital und Tiefenau64833732275142%81552688157
Biel, Spitalzentrum90352437942%15390619154
Brig, Centre de Cardiologie du Valais33619614042%12020
Chur, Kantonsspital Graubünden112747465358%178154551447
Frauenfeld, Kantonsspital Thurgau69138630544%63411111
Fribourg, Hôpital cantonal21871111107649%198141171781782
Genf, Clinique des Grangettes56825531355%13223185
Genf, Hôpital de la Tour82050831238%412016124
Genf, Hôpitaux universitaires1893100189247%1232292052n.a.n.a.
Genolier, Clinique de Genolier44019924155%2541
Kreuzlingen, Herz-Neuro-Zentrum Bodensee123557865753%8742182121
Lachen, Spital1901306032%744
Lausanne, Centre hospitalier universitaire vaudois22491233101645%38129818544014
Lausanne, Clinique Cecil2098123486441%38147n.a.n.a.
Lausanne, Clinique de la Source104052251850%495252
Liestal, Kantonsspital Baselland93340652756%174548815625
Lugano, Cardiocentro Ticino24021037136557%2932273031283
Luzern, Kantonsspital32791858142143%2733889917713542
Luzern, Klinik St. Anna119645374362%62381940328
Morges, Hôpital47325521846%67114122
Pfäffikon, Cardiance Clinic39519320251%3411212
Sion, Hôpital du Valais143674968748%2251651525205
Solothurn, Bürgerspital139164874353%305134
St. Gallen, Kantonsspital27401426131448%2672222825916296
Winterthur, Kantonsspital129352377060%1571732233285
Zürich, Hirslanden Klinik25911320127149%10795921192
Zürich, Klinik im Park111160650545%39339261611
Zürich, Triemli Stadtspital29711557141448%4184005265n.a.n.a.
Zürich, Universitätsspital35141746176850%425341n.a.n.a.n.a.n.a.
Total 57309299912731847%5923442666717391164257

CA = coronary angiography; CTO = chronic total occlusion; n.a. = not available; NST-ACS = non-ST-segment elevation acute coronary syndromes; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction

Table 3

Characteristics of the coronary interventions: access and stenting.

CentreRadial access for CARadial access for PCIRadial access for CA (rate)Radial access for PCI (rate)BMSDESSelf-expandable stents (DES or BMS)Bioabsorbable scaffolds (Absorb, Magmaris, etc.)Bifurcation dedicated stents
Aarau, Hirslanden Klinik27212547%61%1195
Aarau, Kantonsspital94654642%56%934
Baden, Kantonsspital17113731%83%1615
Basel, St. Claraspital793016%15%191
Basel, Universitätsspital170175068%62%112823
Bern, Klinik Beau-Siten.a.248n.a.36%857
Bern, Lindenhofspital116164883%88%718243
Bern, Universitätsspital und Tiefenau3985189561%69%124991
Biel, Spitalzentrum47324352%64%371
Brig, Centre de Cardiologie du Valais33013998%99%135
Chur, Kantonsspital Graubünden77641069%63%1004
Frauenfeld, Kantonsspital Thurgau47622169%72%2951
Fribourg, Hôpital cantonal34916216%15%21074
Genf, Clinique des Grangettes53928995%92%545
Genf, Hôpital de la Tour65125379%81%293
Genf, Hôpitaux universitaires167082188%92%2794n.a.n.a.
Genolier, Clinique de Genolier16514838%61%221
Kreuzlingen, Herz-Neuro-Zentrum Bodensee83867168%102%649
Lachen, Spital1635286%87%60
Lausanne, Centre hospitalier universitaire vaudois157378570%77%69566
Lausanne, Clinique Cecil84453740%62%7804
Lausanne, Clinique de la Source71635169%68%34484
Liestal, Kantonsspital Baselland83346089%87%48723
Lugano, Cardiocentro Ticino91393238%68%13381017
Luzern, Kantonsspital1542117947%83%14218
Luzern, Klinik St. Anna39033133%45%5904
Morges, Hôpital17616137%74%1209
Pfäffikon, Cardiance Clinic744319%21%201
Sion, Hôpital du Valais112054278%79%680
Solothurn, Bürgerspital37117627%24%697
St. Gallen, Kantonsspital2201119880%91%1314113
Winterthur, Kantonsspital75241258%54%7247
Zürich, Hirslanden Klinik65769525%55%111922
Zürich, Klinik im Park52127447%54%437
Zürich, Triemli Stadtspital1200100040%71%14122
Zürich, Universitätsspitaln.a.n.a.n.a.n.a.35122n.a.
Total286281686456%66%55285826461243

BMS = bare metal stents; CA = coronary angiography; DES = drug-eluting stent; n.a. = not available; PCI = percutaneous coronary intervention

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Figure 2

Coronary interventions in Switzerland: summary 2018 and development 2006–2018. CA = coronary angiography; PCI = percutaneous coronary intervention

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Figure 3

Transcatheter aortic valve implantations (TAVI) during the year 2018 in Switzerland.

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Figure 4

Transcatheter aortic valve implantations in Switzerland: summary 2018 and development 2007–2018.

Among all stents, the drug-eluting stent (DES) was almost always the stent type applied (99%). Bare metal stents (BMSs), bioresorbable or self-expandable stents were used in a minority of patients only (0.2, 0.2 and 0.2%, respectively). PCI in chronic total occlusion (CTO) was performed in 6.4% of all PCI cases (1739 patients), whereas the majority of CTO cases the procedure was done by the antegrade route (82% of CTO cases; table 3).

Emergency interventions in patients with a STEMI accounted for 16% of PCI procedures, whereas 22% of patients presented with NSTE-ACS. PCI for cardiogenic shock accounted for 2.4% of all PCI cases (table 2). In 2018, mechanical support systems were used in 494 patients (1.8% of PCI cases; Impella [Abiomed Inc, Danvers MA] in 231 patients, intra-aortic balloon pumps in 176 patients and extracorporeal membrane oxygenation in 87 patients). Pericardial drainage was performed in 322 patients. A catheter-based therapy of pulmonary embolism (e.g., EKOS) was performed in 98 patients (table 4).

Table 4

Characteristics of the coronary interventions: revascularisation techniques (other than balloon angioplasty), pressure measurements and mechanical support systems.

CentreRotablator (number of cases)Thrombus aspirationDistal protection deviceFFRiFRIVUSOCTIABPImpellaECMO
Aarau, Hirslanden Klinik201
Aarau, Kantonsspital1884670947114
Baden, Kantonsspital4522
Basel, St. Claraspital599442040406
Basel, Universitätsspital245721201928412
Bern, Klinik Beau–Site88941
Bern, Lindenhofspital4
Bern, Universitätsspital und Tiefenau40201422292221794525
Biel, Spitalzentrum414222
Brig, Centre de Cardiologie du Valais5710
Chur, Kantonsspital Graubünden75511624115
Frauenfeld, Kantonsspital Thurgau21346
Fribourg, Hôpital cantonal112977135893
Genf, Clinique des Grangettes537411
Genf, Hôpital de la Tour11146712116
Genf, Hôpitaux universitaires164022239403555
Genolier, Clinique de Genolier5110817
Kreuzlingen, Herz–Neuro–Zentrum Bodensee151453
Lachen, Spital153
Lausanne, Centre hospitalier universitaire vaudois28149619532681013
Lausanne, Clinique Cecil1211511
Lausanne, Clinique de la Source11149
Liestal, Kantonsspital Baselland114347324
Lugano, Cardiocentro Ticino38715105248498116311
Luzern, Kantonsspital22841197109032474
Luzern, Klinik St. Anna811222324
Morges, Hôpital512299
Pfäffikon, Cardiance Clinic11221
Sion, Hôpital du Valais2212112103
Solothurn, Bürgerspital691135
St. Gallen, Kantonsspital11414531411225616221110
Winterthur, Kantonsspital1020251292793
Zürich, Hirslanden Klinik552825341354
Zürich, Klinik im Park218167103
Zürich, Triemli Stadtspital5251293201716
Zürich, Universitätsspital45n.a.n.a.75n.a.11955n.a.30n.a.
Total4031282792569157353486717623187

ECMO = extracorporeal membrane oxygenation; FFR = fractional flow reserve; IABP = intra–aortic balloon counterpulsation; iFR = instant wave free ratio; IVUS = intravascular ultrasound; n.a. = not available; OCT = intravascular optical coherence tomography

Intracoronary pressure measurements (fractional flow reserve [FFR] or instant wave free ration [iFR]) were made in 2569 (9.4%) and 1573 (5.8%) patients, respectively. Intravascular ultrasound (IVUS) and intravascular optical coherence tomography (OCT) was performed in 534 (1.9%) and in 867 (3.2%) patients, respectively. Distal protection devices were used in 79 patients (0.3% of PCI cases). Revascularisation techniques other than balloon angioplasty included rotablation (403 patients, 1.5% of PCI cases) and thrombus aspiration (1282 patients, 4.7%; table 4).

Outcome in coronary interventions

The mean overall in-hospital mortality rate after PCI was 1.0%. The mortality rate after PCI for stable CAD was 0.2%, after PCI for NSTE-ACS 1.2%, after PCI for STEMI 4.3% and after PCI for cardiogenic shock or cardiac arrest 26.2% (fig. 2).

Development over recent years

Since 2006, almost all Swiss interventional centres report their data to the Swiss Working Group Interventional Cardiology of the Swiss Society of Cardiology. Since 2010, the number of facilities with a cardiac catheterisation laboratory increased from 33 to 36, corresponding to a total increase in cardiac catheterisation rooms from 50 in 2011 to 60 in 2018. The number of facilities with on-site cardiac surgery remained stable at 16 centres. Accordingly, the number of operators performing PCI rose from 144 in 2011 to 224 in 2018. The evolution of cases of CA and PCI is shown in figure 2. The ratio of PCI to CA remained virtually the same over the years (47% in 2010 and 47% in 2018) [8]. The percentage of radial access increased steadily from 15% in 2010 to 35% in 2014, and reached now 47% in 2018, reflecting the adoption of new recommendations. The number of PCIs per 100,000 inhabitants increased steadily from 254/100,000 in 2010 to 320/100,000 in 2018. Mortality rates were comparable to reports from previous years [8].

Structural interventions

Eleven years after its first introduction in Switzerland in 2007, TAVI continued to increase over the years with a slight flattening since 2016 (from 382 procedures performed in 11 centres in 2010 to 1781 cases in 15 centres in 2018) (figs 3 and 4). Most cases currently are performed by the transfemoral route (1663 patients, 93% of all cases).Access via the transapical (52 patients, 1.9%), trans-subclavian (19 patients, 1.1%) trans-carotid (23 patients, 1.3%), direct aortic (20 patients, 1.1%) and transcaval (5 patients, 0.3%) routes are less often used (figs 3 and 4, table 5).

Table 5

Structural interventions: aortic valve.

CentreAortic valvuloplasty without percutaneous valve replacementTAVITrans-femoral TAVITrans-apical TAVITrans-subclavian TAVIDirect aortic TAVITrans-carotid TAVITrans-caval TAVIUse of embolic protection device during TAVI
Aarau, Hirslanden Klinik1611592
Aarau, Kantonsspital
Baden, Kantonsspital
Basel, St. Claraspital1
Basel, Universitätsspital2118108552
Bern, Klinik Beau-Site52475
Bern, Lindenhofspital
Bern, Universitätsspital und Tiefenau299289552
Biel, Spitalzentrum
Brig, Centre de Cardiologie du Valais
Chur, Kantonsspital Graubünden
Frauenfeld, Kantonsspital Thurgau
Fribourg, Hôpital cantonal
Genf, Clinique des Grangettes
Genf, Hôpital de la Tour124231
Genf, Hôpitaux universitaires686715
Genolier, Clinique de Genolier
Kreuzlingen, Herz-Neuro-Zentrum Bodensee302721
Lachen, Spital
Lausanne, Centre hospitalier universitaire vaudois100787312
Lausanne, Clinique Cecil1675711
Lausanne, Clinique de la Source
Liestal, Kantonsspital Baselland
Lugano, Cardiocentro Ticino47950141512
Luzern, Kantonsspital51071034
Luzern, Klinik St. Anna
Morges, Hôpital
Pfäffikon, Cardiance Clinic
Sion, Hôpital du Valais
Solothurn, Bürgerspital
St. Gallen, Kantonsspitaln.a.
Winterthur, Kantonsspital
Zürich, Hirslanden Klinik157157
Zürich, Klinik im Park3605721
Zürich, Triemli Stadtspital10190101
Zürich, Universitätsspital3583517n.a.
Total171781166352192023521

n.a. = not available; TAVI = transcatheter aortic valve implantation

Nine years after its introduction in 2009, transcatheter mitral edge-to-edge repair procedures using the Mitraclip device (Abbott Strucural Heart, Santa Clara CA) showed a pronounced increase from 67 cases in 4 centres in 2010 to 382 cases in 14 centres in 2018 (table 6a). Additionally, transcatheter direct mitral annuloplasty using the Cardioband device (Edwards Lifesciences, Irvine CA) was performed in nine patients and indirect mitral annuloplasty using the Carillon device (Cardiac Dimensions, Kirkland, WA) in six patients in two centres in Switzerland. Transcatheter tricuspid interventions (32 patients), pulmonal valvuloplasty (33 patients), and transcatheter pulmonary valve implantations (6 patients) were performed in 8 centres in Switzerland. Detailed information on TAVI and mitral transcatheter edge-to-edge repair procedures performed in Switzerland can be found in the SwissTAVI [9] and MitraSwiss [10] registries.

Table 6

a: Structural interventions: other.

CentreOcclusion of para-valvular leakagePercutaneous transvenous mitral valvuloplastyMitral edge-to-edge repair devices (e.g. Mitraclip, Pascal)Transcatheter direct mitral annuloplasty (e.g. Cardioband, Accucinch)Transcatheter indirect mitral annuloplasty (e.g. Carillon)Transcatheter tricuspid valve interventionPTA / stenting pulmonary arteryTranscatheter pulmonary valvuloplastyTPVI (e.g. Melody)
Aarau, Hirslanden Klinik11
Aarau, Kantonsspital51
Baden, Kantonsspital
Basel, St. Claraspital
Basel, Universitätsspital221631
Bern, Klinik Beau–Site
Bern, Lindenhofspital
Bern, Universitätsspital und Tiefenau13270103251
Biel, Spitalzentrum
Brig, Centre de Cardiologie du Valais
Chur, Kantonsspital Graubünden
Frauenfeld, Kantonsspital Thurgau
Fribourg, Hôpital cantonal9
Genf, Clinique des Grangettes
Genf, Hôpital de la Tour
Genf, Hôpitaux universitaires120
Genolier, Clinique de Genolier
Kreuzlingen, Herz–Neuro–Zentrum Bodensee1
Lachen, Spital
Lausanne, Centre hospitalier universitaire vaudois65211143
Lausanne, Clinique Cecil
Lausanne, Clinique de la Source
Liestal, Kantonsspital Baselland
Lugano, Cardiocentro Ticino1161
Luzern, Kantonsspital33362
Luzern, Klinik St. Anna6
Morges, Hôpital
Pfäffikon, Cardiance Clinic
Sion, Hôpital du Valais
Solothurn, Bürgerspital
St. Gallen, Kantonsspital2
Winterthur, Kantonsspital
Zürich, Hirslanden Klinik3375
Zürich, Klinik im Park125
Zürich, Triemli Stadtspital1131
Zürich, Universitätsspital86656661
Total392038296323396

PTA = percutaneous transluminal angioplasty; TPVI = transcatheter pulmonary valve implantation

We noted an increase in left atrial appendage (LAA) closure from 117 in 2011 to 406 in 2018 and an increase of paravalvular leak closure from 10 in 2011 to 39 in 2018. The number of persistent foramen ovale (PFO) and atrial septal defect (ASD) closures remained roughly stable over the years, with 733 PFO closures in 2010 and 833 in 2018; the corresponding numbers for ASD closures were 142 and 154. Interventional ventricular septal defect (VSD) closures were performed in 11 patients in 2018. TASH, renal denervation and coronary sinus reduction were performed in 34, 11 and 19 cases, respectively, in 2018 (table 6b).

Table 6b

Structural interventions: other.

CentreAlcohol ablation for septal hypertrophyPericardial drainage (ad hoc or scheduled)Catheter-based therapy of pulmonary embolismCatheter-based renal sympathetic denervation for treatment of hypertensionCoronary sinus reductionPFO closureASD closureVSD closureLAA closure
Aarau, Hirslanden Klinik31
Aarau, Kantonsspital258747
Baden, Kantonsspital
Basel, St. Claraspital6
Basel, Universitätsspital1252232520
Bern, Klinik Beau–Site371
Bern, Lindenhofspital911020
Bern, Universitätsspital und Tiefenau44357117628184
Biel, Spitalzentrum36
Brig, Centre de Cardiologie du Valais0
Chur, Kantonsspital Graubünden041
Frauenfeld, Kantonsspital Thurgau012
Fribourg, Hôpital cantonal31931301010
Genf, Clinique des Grangettes3
Genf, Hôpital de la Tour71033
Genf, Hôpitaux universitaires3263240117
Genolier, Clinique de Genolier113
Kreuzlingen, Herz–Neuro–Zentrum Bodensee27
Lachen, Spital56
Lausanne, Centre hospitalier universitaire vaudois1202261832
Lausanne, Clinique Cecil10102
Lausanne, Clinique de la Source21216
Liestal, Kantonsspital Baselland210213
Lugano, Cardiocentro Ticino23715512
Luzern, Kantonsspital33614342113
Luzern, Klinik St. Anna21417
Morges, Hôpital12
Pfäffikon, Cardiance Clinic11721
Sion, Hôpital du Valais1511122
Solothurn, Bürgerspital311710
St. Gallen, Kantonsspital2152737
Winterthur, Kantonsspital421
Zürich, Hirslanden Klinik7351024
Zürich, Klinik im Park58439428
Zürich, Triemli Stadtspital59256829
Zürich, Universitätsspitaln.a.n.a.n.a.n.a.210719486
Total3432298111983315411406
ASD = atrial septal defect; LAA = left atrial appendage; n.a. = not available; PFO = patent foramen ovale; VSD = ventricular septal defect

Limitations

Limitations of this report include the fact that the survey was based on aggregate data submitted by the centres on a voluntary basis and not subjected to monitoring. While all centres provided data for this survey, not all information was available for all items in every centre.

Conclusions

The data collected in 2018 show a high and adequate number of diagnostic and therapeutic coronary procedures in comparison with other countries [11, 12], as well as a significant qualitative leap in advanced intracoronary diagnostic techniques as compared to with from previous years [58]. The increasing dominance of the radial approach and the high rate of PCI as treatment for acute myocardial infarction and ischaemic coronary artery disease are clear indicators of the quality of the Swiss interventional activity. Furthermore, there has been a marked increase in the number of procedures for structural heart disease over the last 10 years, for both TAVI and percutaneous mitral valve repair, which incorporates and reflects current guidelines and European standards.

Acknowledgements

We are indebted to all representatives of the catheterisation laboratories participating in this survey. Furthermore, we acknowledge the effort of all the centres which collected the survey data and completed the questionnaires.

Author contributions

The authors designed the investigation, gathered and analysed the data, vouch for the data and analysis, wrote the paper, and decided to submit it for publication. TN, RT and RJ had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors have read and approved the manuscript. The manuscript and its contents have not been published previously and are not being considered for publications elsewhere in whole or in part in any language, including publicly accessible web sites or e-print servers.

Potential competing interests

TN has received speaker honoraria/consulting honoraria from Beckman Coulter, Bayer, Ortho Clinical Diagnostics and Orion Pharma. RT has received research support from the Swiss National Science Foundation (P300PB_167803), the Swiss Heart Foundation, the Swiss Society of Cardiology, the University Hospital of Basel, as well as speaker honoraria/consulting honoraria from Roche Diagnostics, Abbott Diagnostics, Siemens, Singulex and Brahms. LR reports research grants by Abbott, Biotronik, Boston Scientific, Heartflow, Sanofi and Regeneron and speaker fees by Abbott, AstraZeneca, Amgen, CSL Behring, Occlutech, Sanofi and Vifor. RJ has received speaker honoraria from B. Braun Melsungen AG and Cardionovum and research support from B. Braun Melsungen AG. FN has acted as consultant to Edwards Lifesciences. OM Has received honoraria from Abbott and Edwards Lifesciences. Other authors declare that they have no conflict of interest related to this study.

Correspondence

Prof. Raban Jeger, MD, Department of Cardiology, University Hospital Basel, Petersgraben 4, CH-4031 Basel, raban.jeger[at]usb.ch

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