Coronary and structural heart interventions in Switzerland 2019

DOI: https://doi.org/10.4414/smw.2021.20495

Max Wagenera*, Raphael Twerenbolda*, Stéphane Cookb, Oliver Gaemperlic, Pascal Meierd, Olivier Mullere, Fabian Nietlispachf, Lorenz Raeberg, Daniel Weilenmannh, Raban Jegera

on behalf of the Swiss Working Group Interventional Cardiology of the Swiss Society of Cardiology

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 HerzGefäss Zentrum, Hirslanden Klinik im Park, Zurich, Switzerland

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

h Cardiology, Cantonal Hospital St Gallen, Switzerland

Summary

Since 1987 the Swiss Working Group Interventional Cardiology of the Swiss Society of Cardiology coordinates the assessment of invasive diagnostic and therapeutic heart interventions across Switzerland. The aim of this report is to summarise the data for the year 2019, which was collected using a standardised questionnaire. In 2019, 37 centres performed a total of 57,975 coronary angiographies. In 48.2% of these cases a subsequent percutaneous coronary intervention was performed. Among a broad spectrum of structural heart interventions, we have observed a constant growth of transcatheter aortic valve implantations, and a total of 1912 transcatheter aortic valve implantations were performed in 2019.

Introduction

Despite a decrease in mortality due to evolving therapeutic options and faster access to interventional treatment in past decades, cardiovascular disease still accounts for 45% of all deaths in Europe with about 20% being caused by coronary heart disease [1]. Current guidelines underline the importance of established international and national networks for the management of acute and chronic heart disease [2, 3]. The Working Group Interventional Cardiology of the Swiss Society of Cardiology (SSC) has coordinated the annual assessment of invasive diagnostic and therapeutic procedures across Switzerland since 1987 [4]. On an evolving, standardised questionnaire, the number of the different cardiovascular procedures are collected and published by the Swiss Working Group Interventional Cardiology of the SSC [5–9].

Methods

All interventional cardiology centres across Switzerland were asked to complete a standardised online questionnaire via the Survio® platform. In the event of technical difficulties with the online platform, the questionnaire was completed via a standardised .pdf file. Overall, 69 items were assessed, regarding general information of the catheterisation centres, the interventions for coronary artery and structural heart disease, the indications for the interventions, the material used, and outcome (if available). Details of the variables assessed are listed in the appendix.

Data were collected using Excel® for Windows® and only descriptive statistics are presented, without formal statistical analysis. As no patient information was assessed, and data collection and analysis for in-hospital mortality after interventional procedures were for quality assurance/control purposes only, no formal approval by local institutional review boards and/or written patient consent was required.

Results

Figure 1 Summary of coronary interventions and their outcomes in Switzerland 2019.

In the year 2019, with the addition of one new institution in the canton of Zurich, Switzerland had 37 centres performing interventional cardiac procedures. The interventional centres consist of the 5 university hospitals, 16 non-university public hospitals and 16 private institutions that are distributed over 17 of 26 cantons across Switzerland. Sixteen (43%) of these centres have the possibility to perform cardiac surgery on site (table 1).

Table 1 Interventional cardiology centres in Switzerland 2019.

City, centre Clinic type Canton Number of catheter labs Cardiac surgery on site PCI operators
2019 2018 Difference
Aarau, Hirslanden Klinik* p Aargau * Yes * 14 n.a.
Aarau, Kantonsspital n-u Aargau 2 No 5 5 0
Baden, Kantonsspital n-u Aargau 1 No 4 5 −1
Basel, St. Claraspital p Basel-Stadt 1 No 3 3 0
Basel, University Hospital u Basel-Stadt 2 Yes 9 8 1
Bern, Hirslanden Klinik Beau-Site p Bern 2 Yes 7 7 0
Bern, Lindenhofspital p Bern 2 No 6 4 2
Bern, University Hospital (Inselspital) u Bern 4 Yes 11 11 0
Biel, Spitalzentrum n-u Bern 1 No 4 5 −1
Chur, Kantonsspital Graubünden n-u Graubünden 2 No 4 4 0
Frauenfeld, Spital Thurgau AG n-u Thurgau 1 No 1 6 −5
Fribourg, Hôpital Fribourgeois n-u Fribourg 1 No 6 5 1
Genève, Hirslanden Clinique d. Grangettes p Genève 1 No 4 4 0
Genève, Hôpital de La Tour p Genève 2 Yes 8 8 0
Genève, University Hospitals u Genève 2 Yes 7 5 2
Genolier, Clinique de Genolier p Vaud 1 No 4 4 0
Kreuzlingen, Herz-Neuro-Zentr. Bodensee p Thurgau 1 Yes 6 7 −1
Lachen, Spital Lachen AG n-u Schwyz 1 No 3 6 −3
Lausanne, CHUV u Vaud 2 Yes 6 6 0
Lausanne, Clinique de La Source p Vaud 1 No 4 4 0
Lausanne, Hirslanden Clinique Cecil p Vaud 2 Yes 19 17 2
Liestal, Kantonsspital Baselland n-u Basel-Land 1 No 2 2 0
Lugano, Fondazione Cardiocentro Ticino n-u Ticino 4 Yes 9 9 0
Luzern, Hirslanden Klinik St. Anna p Luzern 1 No 4 5 −1
Luzern, Kantonsspital n-u Luzern 4 Yes 7 5 2
Morges, Hôpital de Morges n-u Vaud 1 No 4 4 0
Pfäffikon, Cardiance Clinic p Schwyz 1 No 3 3 0
Sion, Centre de cardiologie du Valais p Valais 1 No 3 3 0
Sion, Hôpital de Sion n-u Valais 2 Yes 5 5 0
Solothurn, Bürgerspital n-u Solothurn 2 No 4 4 0
St. Gallen, Kantonsspital n-u St. Gallen 3 No 9 8 1
Winterthur, Kantonsspital n-u Winterthur 2 No 5 5 0
Zürich, Herz-Gefäss-Klinik Bethanien p Zürich 1 No 1 - -
Zürich, Hirslanden Klinik p Zürich 2 Yes 14 12 2
Zürich, Klinik Im Park p Zürich 3 Yes 7 6 1
Zürich, Stadtspital Triemli n-u Zürich 3 Yes 7 7 0
Zürich, University Hospital u Zürich 3 Yes 9 8 1
Total 37 17 66 16 214 224 −10

n.a. = not applicable; n-u = non-university community centre; p = private clinic; PCI = percutaneous coronary intervention; u = university centre * No data provided

Diagnostic and interventional procedures for coronary heart disease

There were 214 percutaneous coronary intervention (PCI) operators performing a total of 57,975 coronary angiographies in 66 cathlabs. In 27,959 (48.2%) coronary angiography cases, a subsequent PCI was performed (fig. 1), with a PCI per angiography rate ranging between 20% and 73% among different centres (table 2). The average number of total cases/year and PCIs/year per operator were 271 and 131, respectively (tables 1 and 2 ). Figure 2 displays the numbers of diagnostic and interventional cases per centre, ranked by absolute number. Radial access was used in 66% of all cases, which represents a steep increase compared with 47% observed in 2018 [9]. Of note, radial access rate ranged widely from 15% to 98%, depending on site and operator preference (table 3).

Table 2 Coronary angiographies and percutaneous coronary interventions in Switzerland 2019.

Centre Total number of cases Diagnostic cases only PCI PCI in % of total PCI for
2019 2018 Diff. 2019 2018 Diff. 2019 2018 Diff. 2019 2018 Diff. N-ST
ACS 		STEMI Cardio-genic shock CTO Ante-grade CTO Retro-grade CTO % emergency PCI
Aarau, Hirslanden Klinik* –   582 n.a. – 377 n.a. – 205 n.a. – 35 n.a. – – – – – – –
Aarau, Kantonsspital 1935 2226 −291 988 1249 −261   947 977 −30 49 44 5 262 233 – – – – 52
Baden, Kantonsspital 645   550 95 457 1234 −777   188 166 22 29 30 −1 62 2 0 15 15 0 34
Basel, St. Claraspital 457   500 −43 287 301 −14   170 199 −29 37 40 −3 23 17 0 9 9 0 24
Basel, University Hospital 2649 2489 160 1425 1281 144 1224 1208 16 46 49 −2 314 302 61 88 72 16 55
Bern, Hirslanden Klinik Beau-Site 1319 1582 −263 791 884 −93   528 698 −170 40 44 −4 – – – – – 0 –
Bern, Lindenhofspital 1482 1395 87 692 655 37   790 740 50 53 53 0 98 57 – – – – 20
Bern, University Hospital (Inselspital) 6567 6483 84 3877 3732 145 2690 2751 −61 41 42 −1 468 500 61 159 – – 38
Biel, Spitalzentrum 1074   903 171 612 524 88   462 379 83 43 42 1 90 90 6 34 25 9 40
Chur, Kantonsspital Graubünden 1317 1127 190 553 474 79   764 653 111 58 58 0 192 158 14 79 56 23 48
Frauenfeld, Spital Thurgau AG 713   691 22 381 386 −5   332 305 27 47 44 2 115 3 3 15 15 0 36
Fribourg, Hôpital Fribourgeois 2169 2187 −18 1090 1111 −21 1079 1076 3 50 49 1 841 133 – – – – 90
Genève, Hirslanden Clinique d. Grangettes 693   568 125 330 255 75   363 313 50 52 55 −3 33 3 0 31 26 5 10
Genève, Hôpital de La Tour 771   820 −49 434 508 −74   337 312 25 44 38 6 62 27 3 24 18 6 27
Genève, University Hospitals 1821 1893 −72 988 1001 −13 833 892 −59 46 47 −1 255 250 42 50 32 18 66
Genolier, Clinique de Genolier 491   440 51 212 199 13   279 241 38 57 55 2 – 1 0 9 – – 0
Kreuzlingen, Herz-Neuro-Zentr. Bodensee 1231 1235 −4 687 578 109   544 657 −113 44 53 −9 58 75 4 36 34 2 25
Lachen, Spital Lachen AG 169   190 −21 126 130 −4 43 60 −17 25 32 −6 3 0 0 2 2 0 7
Lausanne, CHUV 2491 2249 242 1468 1233 235 1023 1016 7 41 45 −4 441 309 23 57 42 15 76
Lausanne, Clinique de La Source 1031 1040 −9 519 522 −3   512 518 −6 50 50 0 34 0 0 49 49 0 7
Lausanne, Hirslanden Clinique Cecil 2060 2098 −38 1119 1234 −115   941 864 77 46 41 4 – – – – – – –
Liestal, Kantonsspital Baselland 1001   933 68 381 406 −25   620 527 93 62 56 5 157 55 12 75 – – 36
Lugano, Fondazione Cardiocentro Ticino 2352 2402 −50 1029 1037 −8 1323 1365 −42 56 57 −1 237 217 37 44 31 13 37
Luzern, Hirslanden Klinik St. Anna 1345 1196 149 436 453 −17   909 743 166 68 62 5 82 38 3 55 48 7 14
Luzern, Kantonsspital 3256 3279 −23 1747 1858 −111 1509 1421 88 46 43 3 388 339 103 190 157 34 55
Morges, Hôpital de Morges 389   473 −84 217 255 −38   172 218 −46 44 46 −2 68 3 0 13 13 0 41
Pfäffikon, Cardiance Clinic 433   395 38 217 193 24   216 202 14 50 51 −1 36 3 0 26 24 2 18
Sion, Centre de cardiologie du Valais 723   336 387 347 196 151   376 140 236 52 42 10 5 1 0 35 35 0 2
Sion, Hôpital de Sion 1621 1436 185 823 749 74   798 687 111 49 48 1 213 145 16 50 35 15 47
Solothurn, Bürgerspital 1537 1391 146 609 648 −39   928 743 185 60 53 7 202 126 – – – – 35
St. Gallen, Kantonsspital 2931 2740 191 1510 1436 74 1421 1314 107 48 48 1 281 215 15 141 83 58 36
Winterthur, Kantonsspital 1331 1293 38 507 523 −16   824 770 54 62 60 2 226 234 48 42 37 5 62
Zürich, Herz-Gefäss-Klinik Bethanien† 131   n.a. n.a. 36 – n.a. 96 – n.a. 73 – n.a. 1 0 0 12 12 0 1
Zürich, Hirslanden Klinik 2520 2591 −71 1281 1320 −39 1239 1271 −32 49 49 0 94 79 16 40 38 2 15
Zürich, Klinik Im Park 1202 1111 91 634 606 28   568 505 63 47 45 2 54 52 8 21 16 0 20
Zürich, Stadtspital Triemli 2949 2971 −22 1599 1557 42 1350 1414 −64 46 48 −2 395 375 45 61 – – 60
Zürich, University Hospital 3169 3514 −345 1608 1746 −138 1561 1768 −207 49 50 −1 263 275 125 43 – – 42
Total 57,975 57,309 666 30,017 30,851 −834 27,959 27,318 641 48.2 47.7 0.6 6053 4317 645 1505 924   230

CTO = chronic total occlusions; n.a. = not applicable; N-ST-ACS = non-ST-segment elevation acute coronary syndrome; PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction * No data provided; † estimated numbers

Figure 2 Coronary angiographies and interventions in Switzerland 2019 – centres ranked by total number of cases.

Table 3 Percutaneous coronary intervention details.

Centre Total number of CA Radial access Type of stent used DEB
n % BMS DES Self-expandable (DES or BMS) Bioabsorbable scaffolds Bifurcation dedicated stents
Aarau, Hirslanden Klinik – – – – – – – – –
Aarau, Kantonsspital 1935 1449 75 0   834 0 0 0 –
Baden, Kantonsspital 645 516    80 3   183 0 3 0 15
Basel, St. Claraspital 457 68 15 –   154 – – – 12
Basel, University Hospital 2649 1925    73 0   1126 14 0 0 98
Bern, Hirslanden Klinik Beau-Site 1319 – – – – – – – –
Bern, Lindenhofspital 1482 1275    86 0   790 0 0 120 20
Bern, University Hospital (Inselspital) 6567 4070 62 1   2468 – 0 – 151
Biel, Spitalzentrum 1074 850    79 0   455 0 0 0 3
Chur, Kantonsspital Graubünden 1317 881    67 0   764 0 0 0 5
Frauenfeld, Spital Thurgau AG 713 548 77 0   331 1 0 0 10
Fribourg, Hôpital Fribourgeois 2169 506 23 0   1062 0 0 0 63
Genève, Hirslanden Clinique d. Grangettes 693 650    94 0   348 0 0 0 15
Genève, Hôpital de La Tour 771 683    89 0   309 0 0 0 19
Genève, University Hospitals 1821 830    46 6   744 0 5 0 60
Genolier, Clinique de Genolier 491 323    66 0   235 0 0 0 30
Kreuzlingen, Herz-Neuro-Zentrum 1231 701    57 0   544 0 0 0 12
Lachen, Spital Lachen AG 169 139    82 0 43 0 0 0 0
Lausanne, CHUV 2491 1768 71 –   961 – 3 – 65
Lausanne, Clinique de La Source 1031 711    69 11   481 0 0 0 29
Lausanne, Hirslanden Clinique Cecil 2060 1451 70 6 – 0 0 0 –
Liestal, Kantonsspital Baselland 1001 936 94 0   620 0 30 0 27
Lugano, Fondazione Cardiocentro 2352 1899 81 0   1220 1 29 0 55
Luzern, Hirslanden Klinik St. Anna 1345 715    53 0   852 0 1 0 172
Luzern, Kantonsspital 3256 2637 81 0   1490 10 0 0 24
Morges, Hôpital de Morges 389 149 38 0   163 0 0 – 9
Pfäffikon, Cardiance Clinic 433 220    51 0   215 0 0 0 1
Sion, Centre de cardiologie du Valais 723 712 98 0   344 0 0 0 –
Sion, Hôpital de Sion 1621 1264    78 0   792 – – – 20
Solothurn, Bürgerspital 1537 523 34 0   756 0 0 0 30
St. Gallen, Kantonsspital 2931 2638    90 0   1255 7 3 0 373
Winterthur, Kantonsspital 1331 780 59 1   773 0 0 0 45
Zürich, Herz-Gefäss-Klinik Bethanien* 131 100 76 0 92 0 0 0 3
Zürich, Hirslanden Klinik 2520 1227 49 0   1145 1 0 0 89
Zürich, Klinik Im Park 1202 722 60 0   436 0 0 0 83
Zürich, Stadtspital Triemli 2949 2299 78 0   1340 0 0 0 –
Zürich, University Hospital 3169 1373    43 0   1225 0 0 – 88
Total 57,975 37,538   66% 28 24550 34 74 120 1626
0.1% 99.0% 0.1% 0.3% 0.5%

BMS = bare metal stent; CA = coronary angiography; DEB = drug-eluting balloon; DES = drug-eluting stent; PCI = percutaneous coronary intervention * Estimated numbers

Thirty-four centres provided complete data on reason for PCI (n = 26,490). Among emergency PCIs (42% of total PCIs) non-ST-elevation acute coronary syndromes (ACS), ST-elevation myocardial infarction (STEMI) and cardiogenic shock accounted for 55%, 39% and 6% of cases, respectively (tables 2 and 4 ). Interventions for chronic total occlusions accounted for 6% of PCIs performed, with an antegrade approach used in 61%. Among all coronary interventions, drug-eluting stents were the most commonly used stent type, used in 99% of all cases, with other stent types playing just a minor role (bare metal stents 0.1%, self-expandable stents 0.1%, bioabsorbable scaffolds 0.3%, bifurcation dedicated stents 0.5%) (table 3).

Table 4 Indication for percutaneous coronary intervention.

PCIs with data on PCI indication provided (34 centres) 26,490
Emergency PCIs 11,015   42%   Of total PCIs
Non-ST-ACS 6053   55%   Of emergency PCIs
STEMI 4317   39%
Cardiogenic shock   645   6%

Non-ST-ACS = non-ST-segment elevation acute coronary syndrome; PCI = percutaneous coronary intervention; STEMI = ST-segment-elevation myocardial infarction

Additional techniques for lesion preparation other than balloon angioplasty were used in 1405 (5%) of PCI cases. In 6253 cases (10.8% of total cases) the degree of coronary artery stenosis was quantified by fractional flow reserve (42.3%), instantaneous wave-free ratio (28.7%), intravascular ultrasound (10.0%) or optical coherence tomography (19.0%). With a total of 554 cases (1%), left ventricular assist devices were rarely needed (table 5).

Table 5 Auxiliary coronary revascularisation techniques, quantification methods of coronary stenosis and left ventricular assist devices.

Centre Revascularisation techniques, other than balloon angioplasty, by number of cases Quantification methods of the degree of stenosis Left ventricular assist devices
Rotabl Shock wave Thromb asp Filters FFR iFR IVUS OCT IABP Impella® ECMO Other
Aarau, Hirslanden Klinik* – – – – – – – – – – – –
Aarau, Kantonsspital 12 14 – 6 – – 10 22 1 19 2 0
Baden, Kantonsspital 0 0 16 7   78 0 0 0 0 0 0 0
Basel, St. Claraspital 10 – 14 0 – 54 – 40 1 – – –
Basel, University Hospital 32 0 63 0 103 0 19 18 0 42 2 6
Bern, Hirslanden Klinik Beau-Site 19 0 0 0 0 0 0 0 0 0 0 0
Bern, Lindenhofspital 7 1 2 0 0 0 0 0 0 0 0 0
Bern, University Hospital 34 6 178 6 301 2 51 373 7 55 23 0
Biel, Spitalzentrum 19 0 21 1   42 0 5 4 0 7 0 0
Chur, Kantonsspital Graubünden 11 0 51 0 0 72 7 22 0 15 0 0
Frauenfeld, Spital Thurgau AG 0 2 0 0   18 91 0 24 0 0 0 0
Fribourg, Hôpital Fribourgeois 13 0 78 0   91 0 13 94 5 2 3 0
Genève, Clinique d. Grangettes 5 1 0 1   97 0 0 31 0 0 0 0
Genève, Hôpital de La Tour 7 0 9 2   76 0 13 0 3 0 1 0
Genève, University Hospitals 11 14 58 5 0 218 63 45 4 12 7 2
Genolier, Clinique de Genolier 6 0 0 1 151 151 0 30 0 0 0 0
Kreuzlingen, Herz-Neuro-Zentrum 0 0 26 0 11 148 4 0 0 0 2 0
Lachen, Spital Lachen AG 0 0 0 0   10 0 10 0 0 0 0 0
Lausanne, CHUV 16 – 75 7 250 – 21 115 7 – 4 –
Lausanne, Clinique de La Source 0 0 5 0 156 0 0 0 0 0 0 0
Lausanne, Hirslanden Clinique Cecil 2 0 – – – 0 0 0 0 0 0 0
Liestal, Kantonsspital Baselland 15 2 11 1   36 0 0 21 0 6 0 0
Lugano, Fondazione Cardiocentro 5 10 72 11   54 216 48 38 5 10 8 0
Luzern, Hirslanden Klinik St. Anna 8 0 15 0   68 3 5 0 0 4 0 0
Luzern, Kantonsspital 12 1 – 2 162 0 19 113 15 74 3 0
Morges, Hôpital de Morges 2 – 2 0   38 – – 8 – 1 – –
Pfäffikon, Cardiance Clinic 0 0 1 0 5 40 3 0 0 0 0 0
Sion, Centre de cardiologie d. Valais 0 0 0 0 115 0 0 15 0 0 0 0
Sion, Hôpital de Sion – – 18 – 124 – – 16 12 – 4 –
Solothurn, Bürgerspital 3 21 0 1 139 0 0 0 0 0 0 0
St. Gallen, Kantonsspital 154 19 120 0 183 49 140 43 18 8 28 0
Winterthur, Kantonsspital 5 0 – – 16 133 26 0 3 8 0 0
Zürich, Herz-Gef.-Klinik Bethanien† 3 0 2 0 4 3 7 6 0 0 0 0
Zürich, Hirslanden Klinik 6 3 37 4 – 287 31 7 10 9 1 0
Zürich, Klinik Im Park 4 0 4 2 23 193 3 0 11 2 1 0
Zürich, Stadtspital Triemli 2 10 – 12 164 – 0 53 18 9 1 0
Zürich, University Hospital‡ – – – 0 132 132 126 52 5 33 15 0
Total 423 104 878 69 2647 1792 624 1190 125 316 105 8
  1.5%   0.4%   3.1%   0.2% 42.3% 28.7% 10.0% 19.0% 22.6% 57.0% 19.0% 1.4%
5.0% 10.8% 1.0%
     % of PCI Cases % of TOTAL Cases

ECMO = extracorporeal membrane oxygenation; FFR = fractional flow reserve; IABP = intra-aortic balloon pump; iFR = instantaneous wave-free ratio; IVUS = intravascular ultrasound; OCT = optical coherence tomography; Rotabl = rotablator; thromb asp = thrombus aspiration * No data provided; † estimated numbers; ‡ cardiology department only

Interventions for structural heart disease

As described previously [9], after the steep rise in the early years after its introduction in 2007 there is still a constant growth in case numbers for transcatheter aortic valve implantation (TAVI, fig. 3), reflecting the implementation of TAVI in current guidelines for valvular heart disease [10]. In 2019, 1912 TAVIs were performed, with femoral access being used in 95.5% of implantations (table 6). Figure 4 displays the numbers of TAVIs with transfemoral or alternative access routes per centre, ranked by absolute number.

Table 6 Transcatheter aortic valve implantations in Switzerland 2019.

Centre    Aortic valvuloplasty without percutaneous valve replacement Total number of TAVIs TAVI access Use of embolic protection device during TAVI
2019 2018 Diff. Trans-femoral Trans-apical   Trans- subclavian Direct aortic Trans-carotid Trans-caval
Aarau, Hirslanden Klinik* – – – – – – – – – – –
Aarau, Kantonsspital 0 75 – – 72 0 3 0 0 0 0
Baden, Kantonsspital – – – – – – – – – – –
Basel, St. Claraspital – – – – – – – – – – –
Basel, University Hospital 0 165 118 47 152 8 5 0 0 0 1
Bern, Hirslanden Klinik Beau-Site 0 83 52 31 – – – – – – –
Bern, Lindenhofspital – – – – – – – – – – –
Bern, University Hospital 4 403 299 104 398 1 0 0 0 4 –
Biel, Spitalzentrum – – – – – – – – – – –
Chur, Kantonsspital Graubünden – – – – – – – – – – –
Frauenfeld, Spital Thurgau AG – – – – – – – – – – –
Fribourg, Hôpital Fribourgeois 2 – – – – – – – – – –
Genève, Clinique d. Grangettes – – – – – – – – – – –
Genève, Hôpital de La Tour 1 33 24 9 32 0 1 0 0 0 3
Genève, University Hospitals – 86 68 18 85 1 0 0 0 0 80
Genolier, Clinique de Genolier – – – – – – – – – – –
Kreuzlingen, Herz-Neuro-Zentrum 0 28 30 –2 27 0 0 1 0 0 0
Lachen, Spital Lachen AG – – – – – – – – – – –
Lausanne, CHUV 2 120 100 20 109 2 0 2 7 0 3
Lausanne, Clinique de La Source – – – – – – – – – – –
Lausanne, Hirslanden Clinique Cecil 0 64 67 –3 – – – – – – –
Liestal, Kantonsspital Baselland – – – – – – – – – – –
Lugano, Fondazione Cardiocentro 0 76 79 –3 51 14 0 11 0 0 14
Luzern, Hirslanden Klinik St. Anna – – – – – – – – – – –
Luzern, Kantonsspital 9 116 107 9 116 0 0 0 0 0 76
Morges, Hôpital de Morges – – – – – – – – – – –
Pfäffikon, Cardiance Clinic – – – – – – – – – – –
Sion, Centre de cardiologie du Valais – – – – – – – – – – –
Sion, Hôpital de Sion – – – – – – – – – – –
Solothurn, Bürgerspital – – – – – – – – – – –
St. Gallen, Kantonsspital – – – – – – – – – – –
Winterthur, Kantonsspital 1 – – – – – – – – – –
Zürich, Herz-Gefäss-Klinik Bethanien – – – – – – – – – – –
Zürich, Hirslanden Klinik 0 150 157 –7 149 0 0 1 0 0 3
Zürich, Klinik Im Park 2 75 60 15 74 0 0 1 0 0 0
Zürich, Stadtspital Triemli 0 78 101 –23 69 8 1 0 0 0 0
Zürich, University Hospital 0 360 358 2 349 1 10 0 0 0 140
Total 21 1912 1620 292 1683 35 20 16 7 4 320
% of total 95.4%   2.0%   1.1%   0.9%   0.4%   0.2%

TAVI = transcatheter aortic valve implantation * No data provided

Figure 3 Summary of transcatheter aortic valve implantations in Switzerland 2019.

Figure 4 Transcatheter aortic valve implantations in Switzerland 2019 – centres ranked by total number of cases.

Compared with 2018 there was a decrease in mitral edge-to-edge procedures from 382 to 362 [9]. As for other interventions for structural heart disease, the numbers of left atrial appendix closures decreased from 406 to 317. Interventional closure of patent foramen ovale increased by 33 to 866. Interventions for pulmonary embolism did not differ much compared with 2018 (105 vs 98 cases) (tables 7 and 8 )

Table 7 Interventional valve interventions other than TAVI in Switzerland 2019.

Centre   Occlusion of paravalvular leakage Mitral valve interventions Transcath. tricuspid valve intervention       Pulmonary artery/valve interventions
Percut. transvenous valvuloplasty Edge-to-edge repair devices Direct annuloplasty (e.g., Cardioband®) Indirect mitral annuloplasty (e.g., Carillon®) Transcath.
valve replacement (TMVI, e.g., Tendyne™) 		PTA / stenting pulmonary artery Transcatheter pulmonary valvuloplasty TPVI
(e.g., Melody®)
Aarau, Hirslanden Klinik* – – – – – – – – – –
Aarau, Kantonsspital 2 – 28 – – – – – – –
Baden, Kantonsspital – – – – – – – – – –
Basel, St. Claraspital – – – – – – – – – –
Basel, University Hospital – – 16 4 – 1 1 – – –
Bern, Hirslanden Klinik Beau-Site – – – – – – – – – –
Bern, Lindenhofspital – – – – – – – – – –
Bern, University Hospital (Inselspital) 8 3 66 – – 5 10 36 – 5
Biel, Spitalzentrum – – – – – – – – – –
Chur, Kantonsspital Graubünden – – – – – – – – – –
Frauenfeld, Spital Thurgau AG – – – – – – – – – –
Fribourg, Hôpital Fribourgeois – – 8 – – – – – – –
Genève, Clinique des Grangettes – – – – – – – – – –
Genève, Hôpital de La Tour 3 1 – – – – 1 – – –
Genève, University Hospitals – 1 9 – – 3 – 18 – –
Genolier, Clinique de Genolier – – – – – – – – – –
Kreuzlingen, Herz-Neuro-Zentrum – – 1 – – – – – – –
Lachen, Spital Lachen AG – – – – – – – – – –
Lausanne, CHUV 5 2 18 – – 1 2 2 7 –
Lausanne, Clinique de La Source – – – – – – – – – –
Lausanne, Hirslanden Clinique Cecil – – – – – – – – – –
Liestal, Kantonsspital Baselland – – – – – – – – – –
Lugano, Fondazione Cardiocentro – 2 20 – – – 2 – – –
Luzern, Hirslanden Klinik St. Anna – – 2 – – – – – – –
Luzern, Kantonsspital 1 2 35 – – – 2 – 1 –
Morges, Hôpital de Morges – – – – – – – – – –
Pfäffikon, Cardiance Clinic 1 – – – – – – – – –
Sion, Centre de cardiologie du Valais – – – – – – – – – –
Sion, Hôpital de Sion – – – – – – – – – –
Solothurn, Bürgerspital 1 – – – – – – – – –
St. Gallen, Kantonsspital 1 – 7 – – – – – – –
Winterthur, Kantonsspital – – – – – – – – – –
Zürich, Herz-Gefäss-Klinik Bethanien – – – – – – – – – –
Zürich, Hirslanden Klinik 1 – 44 – – – 6 1 – –
Zürich, Klinik Im Park 4 1 18 – – – 3 – – –
Zürich, Stadtspital Triemli 4 4 10 – – – – – – –
Zürich, University Hospital 1 1 80 1 – – 9 – – 2
Total 32 17 362 5 0 10 36 57 8 7

PTA = percutaneous transluminal angioplasty; TMVI = transcatheter mitral valve implantation; TPVI = transcatheter pulmonary valve implantation * No data provided

Table 8 Non-valvular structural heart and catheter-based pulmonary/renal interventions in Switzerland 2019.

Centre TASH Pericardial drainage (ad hoc or scheduled) Catheter-based therapy
of pulmonary embolism 		Catheter-based renal sympathetic denervation for treatment of hypertension    Coronary sinus reduction Closure devices
PFO ASD VSD LAA
Aarau, Hirslanden Klinik* – – – – – – – – –
Aarau, Kantonsspital – 11 – – – 60 1 – 19
Baden, Kantonsspital – 35 – – – – – – –
Basel, St. Claraspital – 9 – – – – – – –
Basel, University Hospital 1 32 21 – 2 40 3 – 19
Bern, Hirslanden Klinik Beau-Site – – – – – 13 – – –
Bern, Lindenhofspital – 4 – – – 10 – – –
Bern, University Hospital 5 36 70 5 – 157 27 – 102
Biel, Spitalzentrum – 11 – – – 6 3 – –
Chur, Kantonsspital Graubünden 1 5 – – – 4 – – 1
Frauenfeld, Spital Thurgau AG – – – – – 12 – – –
Fribourg, Hôpital Fribourgeois 1 10 6 – – 22 8 – 5
Genève, Hirslanden Clinique des Grangettes – 1 – – – 2 – – –
Genève, Hôpital de La Tour – 8 – – – 12 2 – –
Genève, University Hospitals 3 19 – – – 37 – – 3
Genolier, Clinique de Genolier – 1 – 3 – 4 – – –
Kreuzlingen, Herz-Neuro-Zentrum Bodensee – 3 – – – 12 – – –
Lachen, Spital Lachen AG – 3 – – – 3 – – –
Lausanne, CHUV 2 15 – 3 – 33 14 1 10
Lausanne, Clinique de La Source – 6 – – – 3 – – –
Lausanne, Hirslanden Clinique Cecil – – – 1 – – – – –
Liestal, Kantonsspital Baselland 1 7 5 – – 18 2 – 3
Lugano, Fondazione Cardiocentro Ticino 1 25 1 – 4 23 6 1 9
Luzern, Hirslanden Klinik St. Anna – 2 – – – 10 1 1 3
Luzern, Kantonsspital 7 – 2 – 8 68 7 – 25
Morges, Hôpital de Morges – – – – – 3 – – –
Pfäffikon, Cardiance Clinic 2 1 – – – 12 2 – 3
Sion, Centre de cardiologie du Valais – – – – – – – – –
Sion, Hôpital de Sion – 18 – 2 – 13 – – 3
Solothurn, Bürgerspital – 7 – 1 – 25 – – 7
St. Gallen, Kantonsspital 2 16 – – – 32 3 – 7
Winterthur, Kantonsspital – – – – – 26 – – –
Zürich, Herz-Gefäss-Klinik Bethanien† – 5 – – – – – – –
Zürich, Hirslanden Klinik – 15 – 1 – 36 7 – 30
Zürich, Klinik Im Park 7 10 – 4 – 45 4 1 10
Zürich, Stadtspital Triemli 5 17 – – 2 70 12 – 25
Zürich, University Hospital – 24 – – – 55 21 4 33
Total 38 356 105 20 16 866 123 8 317

ASD = atrial septal defect; LAA = left atrial appendix; PFO = patent foramen ovale; VSD = ventricular septal defect * No data provided; † estimated data

Outcome

Only few centres (n = 14) reported data on in-hospital mortality, thus the percentages may not be representative. With interventions for chronic coronary artery disease, non-ST-elevation ACS, STEMI, and cardiogenic shock, there was an in-hospital mortality of 0.1%, 1.8%, 5.4%, and 25.1%, respectively, which was comparable to the previous year. In patients undergoing a TAVI procedure, an in-hospital mortality of 1.0% was observed.

Limitations

The main limitation of this study is the result of its design, with data being submitted on a voluntary basis by the individual centres. By sending a standardised questionnaire to all the involved centres we tried to minimise this effect. Unfortunately, not all centres were able to retrospectively collect and submit answers to all items of the questionnaire (missing information from Kardiologie Mittelland/Hirslanden Klinik Aarau, and Herz-Gefäss-Klinik Bethanien, Zürich). Definition of chronic coronary artery disease, non-ST-elevation ACS, STEMI, and cardiogenic shock was based on international guidelines but not predefined by the registry, and therefore may differ among the centres

Conclusion

The current national numbers show an increase in interventional procedures for coronary and structural heart disease, specifically for TAVI. Regarding coronary angiography and PCI, the rate of radial access shows a further increase to currently 66%, whereas TAVI procedures are performed by the transfemoral route in 96% of cases. Other structural interventions such as mitral edge-to- edge repair, and patent foramen ovale and left atrial appendix occlusions seemed to stabilise at a high level. Overall, the information gathered shows performance numbers in interventional cardiology for Switzerland comparable to its European neighbours [11–14].

As a result of a tight and functional national network of the Swiss Working Group for interventional Cardiology, nationwide data on interventions for coronary and structural heart disease were collected. National data collection and registries remain an important tool to assess performance of a healthcare system and confirm the outcomes and safety of procedures in interventional cardiology [15, 16].

Appendix Data collected within the registry

General information of the catheterisation centre (hospital and city), catheter labs (number), number of percutaneous coronary interventions (PCIs) operators, number of diagnostic operators (no PCI), centre with cardiac surgery (yes or no) and name of catheterisation database.

Interventions for coronary artery disease:

Data on outcome (if available):

Notes

Disclosure statement

LR reports grants to the institution from Abbott, Sanofi, Regeneron, Medis, Biotronik, Boston Scientific and speaker or consultation fees by Abbott, AstraZeneca, Amgen, Occlutech, Canon, Sanofi and Vifor. FN has served as consultant for Edwards Lifesciences and Abbott. The other authors report no financial support and no other potential conflict of interest relevant to this article.

Note added after publication

The originally published version of this article contained an incorrect version of figure 1. This has been corrected.

* Equal first authors

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Notes

*

Equal first authors

Disclosure statement

LR reports grants to the institution from Abbott, Sanofi, Regeneron, Medis, Biotronik, Boston Scientific and speaker or consultation fees by Abbott, AstraZeneca, Amgen, Occlutech, Canon, Sanofi and Vifor. FN has served as consultant for Edwards Lifesciences and Abbott. The other authors report no financial support and no other potential conflict of interest relevant to this article.

Note added after publication

The originally published version of this article contained an incorrect version of figure 1. This has been corrected.