Coronary and structural heart interventions in Switzerland 2018

DOI: https://doi.org/10.4414/smw.2020.20200

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

for the Working Group Interventional Cardiology of the Swiss Society of Cardiology

aCardiology, University Hospital Basel, University of Basel, Switzerland

bCardiology, Cantonal Hospital Fribourg, Switzerland

cHeartClinic, Hirslanden Hospital Zurich, Switzerland

dCardiology, Cantonal Hospital Chur, Switzerland

eCardiology, University Hospital Lausanne, University of Lausanne, Switzerland

fHerzGefässZentrum, Hirslanden Klinik im Park, Zurich, Switzerland

gCardiology, University Hospital Bern, University of Bern, Switzerland

hCardiology, 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.

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 [1–3]. 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 [5–8].

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.

Centre Clinic description Canton Number of catheter labs PCI operators Operators diagnostic only Cardiac surgery onsite
Aarau, Hirslanden Klinik Non-university community centre Aargau 2 14 – Yes
Aarau, Kantonsspital Non-university community centre Aargau 2 5 5 No
Baden, Kantonsspital Non-university community centre Aargau 1 5 – No
Basel, St. Claraspital Private clinic Basel-Stadt 1 3 – No
Basel, Universitätsspital University centre Basel-Stadt 2 8 1 Yes
Bern, Klinik Beau-Site Private clinic Bern 2 7 – Yes
Bern, Lindenhofspital Private clinic Bern 2 4 3 No
Bern, Universitätsspital und Tiefenau University centre Bern 4 11 – Yes
Biel, Spitalzentrum Non-university community centre Bern 1 5 – No
Brig, Centre de Cardiologie du Valais Private clinic Wallis 1 3 – No
Chur, Kantonsspital Graubünden Non-university community centre Graubünden 1 4 – No
Frauenfeld, Kantonsspital Thurgau Non-university community centre Thurgau 1 6 1 No
Fribourg, Hôpital cantonal Non-university community centre Freiburg 1 5 – No
Genf, Clinique des Grangettes Private clinic Genf 1 4 3 No
Genf, Hôpital de la Tour Private clinic Genf 2 8 3 Yes
Genf, Hôpitaux universitaires University centre Genf 2 5 – Yes
Genolier, Clinique de Genolier Private clinic Waadt 1 4 – No
Kreuzlingen, Herz-Neuro-Zentrum Bodensee Private clinic Thurgau 1 7 – Yes
Lachen, Spital Non-university community centre Schwyz 1 6 1 No
Lausanne, Centre hospitalier universitaire vaudois University centre Waadt 2 6 – Yes
Lausanne, Clinique Cecil Private clinic Waadt 1 17 11 Yes
Lausanne, Clinique de la Source Private clinic Waadt 1 4 1 No
Liestal, Kantonsspital Baselland Non-university community centre Basel-Landschaft 1 2 – No
Lugano, Cardiocentro Ticino Non-university community centre Tessin 4 9 1 Yes
Luzern, Kantonsspital Non-university community centre Luzern 2 5 – Yes
Luzern, Klinik St. Anna Private clinic Luzern 1 5 1 No
Morges, Hôpital Non-university community centre Waadt 1 4 4 No
Pfäffikon, Cardiance Clinic Private clinic Schwyz 1 3 1 No
Sion, Hôpital du Valais Non-university community centre Wallis 2 5 – Yes
Solothurn, Bürgerspital Non-university community centre Solothurn 1 4 – No
St. Gallen, Kantonsspital Non-university community centre St. Gallen 3 8 – No
Winterthur, Kantonsspital Non-university community centre Zürich 2 5 – No
Zürich, Hirslanden Klinik Private clinic Zürich 2 12 – Yes
Zürich, Klinik im Park Private clinic Zürich 2 6 1 Yes
Zürich, Triemli Stadtspital Non-university community centre Zürich 2 7 – Yes
Zürich, Universitätsspital University centre Zürich 2 8 – Yes
Total 17 59 224 37 16

PCI = percutaneous coronary intervention

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.

Centre Total number of cases
(CA + PCI) 		Diagnostic cases only
(CA only) 		PCI % PCI per CA PCI for NST-ACS PCI for STEMI PCI for cardiogenic shock / cardiac arrest PCI for CTO Antegrade CTO Retrograde CTO
Aarau, Hirslanden Klinik 582 377 205 35% 32 17 3 15 15 –
Aarau, Kantonsspital 2226 1249 977 44% 311 238 23 129 117 12
Baden, Kantonsspital 550 384 166 30% 82 – – 21 21 –
Basel, St. Claraspital 500 301 199 40% 25 8 1 6 6 –
Basel, Universitätsspital 2489 1281 1208 49% 296 272 90 64 56 8
Bern, Klinik Beau-Site 1582 884 698 44% 92 46 – n.a. n.a. n.a.
Bern, Lindenhofspital 1395 655 740 53% 92 64 87 10 10 –
Bern, Universitätsspital und Tiefenau 6483 3732 2751 42% 815 526 88 157 – –
Biel, Spitalzentrum 903 524 379 42% 153 90 6 19 15 4
Brig, Centre de Cardiologie du Valais 336 196 140 42% 1 – – 20 20 –
Chur, Kantonsspital Graubünden 1127 474 653 58% 178 154 5 51 44 7
Frauenfeld, Kantonsspital Thurgau 691 386 305 44% 63 4 – 11 11 1
Fribourg, Hôpital cantonal 2187 1111 1076 49% 198 141 17 178 178 2
Genf, Clinique des Grangettes 568 255 313 55% 13 2 – 23 18 5
Genf, Hôpital de la Tour 820 508 312 38% 41 20 – 16 12 4
Genf, Hôpitaux universitaires 1893 1001 892 47% 123 229 20 52 n.a. n.a.
Genolier, Clinique de Genolier 440 199 241 55% – 2 – 5 4 1
Kreuzlingen, Herz-Neuro-Zentrum Bodensee 1235 578 657 53% 87 42 18 21 21 –
Lachen, Spital 190 130 60 32% 7 – – 4 4 –
Lausanne, Centre hospitalier universitaire vaudois 2249 1233 1016 45% 381 298 18 54 40 14
Lausanne, Clinique Cecil 2098 1234 864 41% 38 1 – 47 n.a. n.a.
Lausanne, Clinique de la Source 1040 522 518 50% 49 – – 52 52 –
Liestal, Kantonsspital Baselland 933 406 527 56% 174 54 8 81 56 25
Lugano, Cardiocentro Ticino 2402 1037 1365 57% 293 227 30 31 28 3
Luzern, Kantonsspital 3279 1858 1421 43% 273 388 99 177 135 42
Luzern, Klinik St. Anna 1196 453 743 62% 62 38 19 40 32 8
Morges, Hôpital 473 255 218 46% 67 1 – 14 12 2
Pfäffikon, Cardiance Clinic 395 193 202 51% 34 1 – 12 12 –
Sion, Hôpital du Valais 1436 749 687 48% 225 165 15 25 20 5
Solothurn, Bürgerspital 1391 648 743 53% 305 134 – – – –
St. Gallen, Kantonsspital 2740 1426 1314 48% 267 222 28 259 162 96
Winterthur, Kantonsspital 1293 523 770 60% 157 173 22 33 28 5
Zürich, Hirslanden Klinik 2591 1320 1271 49% 107 95 9 21 19 2
Zürich, Klinik im Park 1111 606 505 45% 39 33 9 26 16 11
Zürich, Triemli Stadtspital 2971 1557 1414 48% 418 400 52 65 n.a. n.a.
Zürich, Universitätsspital 3514 1746 1768 50% 425 341 n.a. n.a. n.a. n.a.
Total 57309 29991 27318 47% 5923 4426 667 1739 1164 257

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.

Centre Radial access for CA Radial access for PCI Radial access for CA (rate) Radial access for PCI (rate) BMS DES Self-expandable stents (DES or BMS) Bioabsorbable scaffolds (Absorb, Magmaris, etc.) Bifurcation dedicated stents
Aarau, Hirslanden Klinik 272 125 47% 61% 1 195 – – –
Aarau, Kantonsspital 946 546 42% 56% – 934 – – –
Baden, Kantonsspital 171 137 31% 83% – 161 – 5 –
Basel, St. Claraspital 79 30 16% 15% – 191 – – –
Basel, Universitätsspital 1701 750 68% 62% – 1128 23 – –
Bern, Klinik Beau-Site n.a. 248 n.a. 36% – 857 – – –
Bern, Lindenhofspital 1161 648 83% 88% – 718 – – 243
Bern, Universitätsspital und Tiefenau 3985 1895 61% 69% 1 2499 – 1 –
Biel, Spitalzentrum 473 243 52% 64% – 371 – – –
Brig, Centre de Cardiologie du Valais 330 139 98% 99% – 135 – – –
Chur, Kantonsspital Graubünden 776 410 69% 63% – 1004 – – –
Frauenfeld, Kantonsspital Thurgau 476 221 69% 72% – 295 1 – –
Fribourg, Hôpital cantonal 349 162 16% 15% 2 1074 – – –
Genf, Clinique des Grangettes 539 289 95% 92% – 545 – – –
Genf, Hôpital de la Tour 651 253 79% 81% – 293 – – –
Genf, Hôpitaux universitaires 1670 821 88% 92% 2 794 – n.a. n.a.
Genolier, Clinique de Genolier 165 148 38% 61% – 221 – – –
Kreuzlingen, Herz-Neuro-Zentrum Bodensee 838 671 68% 102% – 649 – – –
Lachen, Spital 163 52 86% 87% – 60 – – –
Lausanne, Centre hospitalier universitaire vaudois 1573 785 70% 77% 6 956 – 6 –
Lausanne, Clinique Cecil 844 537 40% 62% 7 804 – – –
Lausanne, Clinique de la Source 716 351 69% 68% 34 484 – – –
Liestal, Kantonsspital Baselland 833 460 89% 87% – 487 – 23 –
Lugano, Cardiocentro Ticino 913 932 38% 68% – 1338 10 17 –
Luzern, Kantonsspital 1542 1179 47% 83% – 1421 8 – –
Luzern, Klinik St. Anna 390 331 33% 45% – 590 – 4 –
Morges, Hôpital 176 161 37% 74% 1 209 – – –
Pfäffikon, Cardiance Clinic 74 43 19% 21% – 201 – – –
Sion, Hôpital du Valais 1120 542 78% 79% – 680 – – –
Solothurn, Bürgerspital 371 176 27% 24% – 697 – – –
St. Gallen, Kantonsspital 2201 1198 80% 91% – 1314 11 3 –
Winterthur, Kantonsspital 752 412 58% 54% – 724 7 – –
Zürich, Hirslanden Klinik 657 695 25% 55% 1 1192 2 – –
Zürich, Klinik im Park 521 274 47% 54% – 437 – – –
Zürich, Triemli Stadtspital 1200 1000 40% 71% – 1412 2 – –
Zürich, Universitätsspital n.a. n.a. n.a. n.a. – 3512 – 2 n.a.
Total 28628 16864 56% 66% 55 28582 64 61 243

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

Figure 2 Coronary interventions in Switzerland: summary 2018 and development 2006–2018. CA = coronary angiography; PCI = percutaneous coronary intervention

Figure 3 Transcatheter aortic valve implantations (TAVI) during the year 2018 in Switzerland.

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.

Centre Rotablator (number of cases) Thrombus aspiration Distal protection device FFR iFR IVUS OCT IABP Impella ECMO
Aarau, Hirslanden Klinik – – – – 20 – – 1 – –
Aarau, Kantonsspital 18 – 8 46 70 9 47 1 14 –
Baden, Kantonsspital – 4 5 22 – – – – – –
Basel, St. Claraspital 5 99 – 44 20 40 40 6 – –
Basel, Universitätsspital 24 57 2 120 – 19 28 – 41 2
Bern, Klinik Beau–Site 8 8 – 94 – – – 1 – –
Bern, Lindenhofspital 4 – – – – – – – – –
Bern, Universitätsspital und Tiefenau 40 201 4 222 9 22 217 9 45 25
Biel, Spitalzentrum 4 14 – 22 – – – – 2 –
Brig, Centre de Cardiologie du Valais – – – 57 – – 10 – – –
Chur, Kantonsspital Graubünden 7 55 – 11 62 4 11 5 – –
Frauenfeld, Kantonsspital Thurgau – – – 21 34 – 6 – – –
Fribourg, Hôpital cantonal 11 29 – 77 – 13 58 9 – 3
Genf, Clinique des Grangettes 5 – 3 74 – – 11 – – –
Genf, Hôpital de la Tour 11 14 6 71 2 11 – 6 – –
Genf, Hôpitaux universitaires 16 40 2 2 239 40 35 5 – 5
Genolier, Clinique de Genolier 5 – 1 108 – – 17 – – –
Kreuzlingen, Herz–Neuro–Zentrum Bodensee – – – 15 145 3 – – – –
Lachen, Spital – – – 15 – 3 – – – –
Lausanne, Centre hospitalier universitaire vaudois 28 149 6 195 – 32 68 10 – 13
Lausanne, Clinique Cecil 1 2 – 115 – – – 1 – 1
Lausanne, Clinique de la Source – 11 – 149 – – – – – –
Liestal, Kantonsspital Baselland 11 4 3 47 – – 32 – 4 –
Lugano, Cardiocentro Ticino 3 87 15 105 248 49 81 16 3 11
Luzern, Kantonsspital 2 284 1 197 – 10 90 32 47 4
Luzern, Klinik St. Anna 8 – – 112 2 23 – 2 4 –
Morges, Hôpital 5 1 2 29 – – 9 – – –
Pfäffikon, Cardiance Clinic – 1 – 1 22 1 – – – –
Sion, Hôpital du Valais – 22 – 121 – – 12 10 – 3
Solothurn, Bürgerspital 6 9 1 135 – – – – – –
St. Gallen, Kantonsspital 114 145 3 141 122 56 16 22 11 10
Winterthur, Kantonsspital 10 20 – 25 129 27 – – 9 3
Zürich, Hirslanden Klinik 5 – 5 – 282 53 4 13 5 4
Zürich, Klinik im Park 2 1 – 8 167 – – 10 – 3
Zürich, Triemli Stadtspital 5 25 12 93 – – 20 17 16 –
Zürich, Universitätsspital 45 n.a. n.a. 75 n.a. 119 55 n.a. 30 n.a.
Total 403 1282 79 2569 1573 534 867 176 231 87

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.

Centre Aortic valvuloplasty without percutaneous valve replacement TAVI Trans-femoral TAVI Trans-apical TAVI Trans-subclavian TAVI Direct aortic TAVI Trans-carotid TAVI Trans-caval TAVI Use of embolic protection device during TAVI
Aarau, Hirslanden Klinik – 161 159 2 – – – – –
Aarau, Kantonsspital – – – – – – – – –
Baden, Kantonsspital – – – – – – – – –
Basel, St. Claraspital 1 – – – – – – – –
Basel, Universitätsspital 2 118 108 5 5 – – – 2
Bern, Klinik Beau-Site – 52 47 5 – – – – –
Bern, Lindenhofspital – – – – – – – – –
Bern, Universitätsspital und Tiefenau – 299 289 5 – – – 5 2
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 Tour 1 24 23 – 1 – – – –
Genf, Hôpitaux universitaires – 68 67 – 1 – – – 5
Genolier, Clinique de Genolier – – – – – – – – –
Kreuzlingen, Herz-Neuro-Zentrum Bodensee – 30 27 – 2 1 – – –
Lachen, Spital – – – – – – – – –
Lausanne, Centre hospitalier universitaire vaudois – 100 78 7 – 3 12 – –
Lausanne, Clinique Cecil 1 67 57 – – – 11 – –
Lausanne, Clinique de la Source – – – – – – – – –
Liestal, Kantonsspital Baselland – – – – – – – – –
Lugano, Cardiocentro Ticino 4 79 50 14 – 15 – – 12
Luzern, Kantonsspital 5 107 103 4 – – – – –
Luzern, Klinik St. Anna – – – – – – – – –
Morges, Hôpital – – – – – – – – –
Pfäffikon, Cardiance Clinic – – – – – – – – –
Sion, Hôpital du Valais – – – – – – – – –
Solothurn, Bürgerspital – – – – – – – – –
St. Gallen, Kantonsspital – – – – – – – – n.a.
Winterthur, Kantonsspital – – – – – – – – –
Zürich, Hirslanden Klinik – 157 157 – – – – – –
Zürich, Klinik im Park 3 60 57 – 2 1 – – –
Zürich, Triemli Stadtspital – 101 90 10 1 – – – –
Zürich, Universitätsspital – 358 351 – 7 – – – n.a.
Total 17 1781 1663 52 19 20 23 5 21

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.

Centre Occlusion of para-valvular leakage Percutaneous transvenous mitral valvuloplasty Mitral 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 intervention PTA / stenting pulmonary artery Transcatheter pulmonary valvuloplasty TPVI (e.g. Melody)
Aarau, Hirslanden Klinik – – 11 – – – – – –
Aarau, Kantonsspital – – 51 – – – – – –
Baden, Kantonsspital – – – – – – – – –
Basel, St. Claraspital – – – – – – – – –
Basel, Universitätsspital 2 2 16 3 – 1 – – –
Bern, Klinik Beau–Site – – – – – – – – –
Bern, Lindenhofspital – – – – – – – – –
Bern, Universitätsspital und Tiefenau 13 2 70 – – 10 32 5 1
Biel, Spitalzentrum – – – – – – – – –
Brig, Centre de Cardiologie du Valais – – – – – – – – –
Chur, Kantonsspital Graubünden – – – – – – – – –
Frauenfeld, Kantonsspital Thurgau – – – – – – – – –
Fribourg, Hôpital cantonal – – 9 – – – – – –
Genf, Clinique des Grangettes – – – – – – – – –
Genf, Hôpital de la Tour – – – – – – – – –
Genf, Hôpitaux universitaires 1 – 20 – – – – – –
Genolier, Clinique de Genolier – – – – – – – – –
Kreuzlingen, Herz–Neuro–Zentrum Bodensee – – 1 – – – – – –
Lachen, Spital – – – – – – – – –
Lausanne, Centre hospitalier universitaire vaudois 6 5 21 – – 1 1 4 3
Lausanne, Clinique Cecil – – – – – – – – –
Lausanne, Clinique de la Source – – – – – – – – –
Liestal, Kantonsspital Baselland – – – – – – – – –
Lugano, Cardiocentro Ticino – – 11 – – 6 – – 1
Luzern, Kantonsspital 3 3 36 – – 2 – – –
Luzern, Klinik St. Anna – – 6 – – – – – –
Morges, Hôpital – – – – – – – – –
Pfäffikon, Cardiance Clinic – – – – – – – – –
Sion, Hôpital du Valais – – – – – – – – –
Solothurn, Bürgerspital – – – – – – – – –
St. Gallen, Kantonsspital 2 – – – – – – – –
Winterthur, Kantonsspital – – – – – – – – –
Zürich, Hirslanden Klinik 3 – 37 – – 5 – – –
Zürich, Klinik im Park – 1 25 – – – – – –
Zürich, Triemli Stadtspital 1 1 3 – – 1 – – –
Zürich, Universitätsspital 8 6 65 6 6 6 – – 1
Total 39 20 382 9 6 32 33 9 6

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.

Centre Alcohol ablation for septal hypertrophy Pericardial drainage (ad hoc or scheduled) Catheter-based therapy of pulmonary embolism Catheter-based renal sympathetic denervation for treatment of hypertension Coronary sinus reduction PFO closure ASD closure VSD closure LAA closure
Aarau, Hirslanden Klinik – – – – – 3 – – 1
Aarau, Kantonsspital 2 – – – – 58 7 – 47
Baden, Kantonsspital – – – – – – – – –
Basel, St. Claraspital – 6 – – – – – – –
Basel, Universitätsspital 1 25 2 – 2 32 5 – 20
Bern, Klinik Beau–Site – – – – – 3 7 – 1
Bern, Lindenhofspital – 9 1 – – 10 20 – –
Bern, Universitätsspital und Tiefenau 4 43 57 1 – 176 28 1 84
Biel, Spitalzentrum – 3 – – – 6 – – –
Brig, Centre de Cardiologie du Valais – – – – – 0 – – –
Chur, Kantonsspital Graubünden – 0 – – – 4 – 1 –
Frauenfeld, Kantonsspital Thurgau – 0 – – – 12 – – –
Fribourg, Hôpital cantonal 3 19 3 – 1 30 10 – 10
Genf, Clinique des Grangettes – – – – – 3 – – –
Genf, Hôpital de la Tour – 7 – – – 10 3 – 3
Genf, Hôpitaux universitaires 3 26 32 – – 40 1 – 17
Genolier, Clinique de Genolier – 1 – 1 – 3 – – –
Kreuzlingen, Herz–Neuro–Zentrum Bodensee – 2 – – – 7 – – –
Lachen, Spital – 5 – – – 6 – – –
Lausanne, Centre hospitalier universitaire vaudois 1 20 – 2 – 26 18 3 2
Lausanne, Clinique Cecil – 10 – – – 10 – – 2
Lausanne, Clinique de la Source 2 12 – – 1 6 – – –
Liestal, Kantonsspital Baselland 2 10 2 – – 13 – – –
Lugano, Cardiocentro Ticino – 23 – – 7 15 5 – 12
Luzern, Kantonsspital 3 36 1 – 4 34 2 1 13
Luzern, Klinik St. Anna – 2 – 1 – 4 – 1 7
Morges, Hôpital – 1 – – – 2 – – –
Pfäffikon, Cardiance Clinic 1 1 – – – 7 2 – 1
Sion, Hôpital du Valais – 15 – 1 – 11 2 – 2
Solothurn, Bürgerspital – 3 – 1 – 17 – – 10
St. Gallen, Kantonsspital 2 15 – – – 27 3 – 7
Winterthur, Kantonsspital – 4 – – – 21 – – –
Zürich, Hirslanden Klinik – 7 – – – 35 10 – 24
Zürich, Klinik im Park 5 8 – 4 – 39 4 – 28
Zürich, Triemli Stadtspital 5 9 – – 2 56 8 – 29
Zürich, Universitätsspital n.a. n.a. n.a. n.a. 2 107 19 4 86
Total 34 322 98 11 19 833 154 11 406
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 [5–8]. 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.

Notes

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.

* Contributed equally to the manuscript 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.

References

1 Windecker S , Kolh P , Alfonso F , Collet JP , Cremer J , et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J. 2014;35(37):2541–619. doi:.https://doi.org/10.1093/eurheartj/ehu278  

2 Nishimura RA , Otto CM , Bonow RO , Carabello BA , Erwin JP, 3rd , Fleisher LA , et al. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(25):e1159–95. doi:.https://doi.org/10.1161/CIR.0000000000000503  

3 Baumgartner H , Falk V , Bax JJ , De Bonis M , Hamm C , Holm PJ , et al.; ESC Scientific Document Group. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(36):2739–91. doi:.https://doi.org/10.1093/eurheartj/ehx391  

4 Meier B . [Local development of coronary angioplasty]. Schweiz Med Wochenschr. 1989;119(30):1033–9. German.  

5 Windecker S , Roffi M , Pedrazzini G , Rickli H , Maeder T , Kaiser A , et al. Interventional Cardiology in Switzerland during the Year 2007. Cardiovasc Med. 2010;13(01):18–24. doi:https://doi.org/10.4414/cvm.2010.01466  

6 Windecker S , Pedrazzini G , Roffi M , Rickli H , Maeder T , Kaiser A , et al. Interventional cardiology in Switzerland during the years 2008 and 2009. Cardiovasc Med. 2010;13(12):370–5. doi:.https://doi.org/10.4414/cvm.2010.01544  

7 Pedrazzini G , Roffi M , Cook S , Corti R , Wenaweser P , Rickli H , et al. Interventional cardiology in Switzerland during the year 2010. Cardiovasc Med. 2012;15(02):48–53. doi:.https://doi.org/10.4414/cvm.2012.01647  

8 Rigamonti F , Fahrni G , Maeder M , Cook S , Weilenmann D , Wenaweser P , et al. Switzerland: coronary and structural heart interventions from 2010 to 2015. EuroIntervention. 2017;13(Z):Z75–9. doi:.https://doi.org/10.4244/EIJ-D-16-00828  

9 Wenaweser P , Stortecky S , Heg D , Tueller D , Nietlispach F , Falk V , et al. Short-term clinical outcomes among patients undergoing transcatheter aortic valve implantation in Switzerland: the Swiss TAVI registry. EuroIntervention. 2014;10(8):982–9. doi:.https://doi.org/10.4244/EIJV10I8A166  

10 Sürder D , Pedrazzini G , Gaemperli O , Biaggi P , Felix C , Rufibach K , et al. Predictors for efficacy of percutaneous mitral valve repair using the MitraClip system: the results of the MitraSwiss registry. Heart. 2013;99(14):1034–40. doi:.https://doi.org/10.1136/heartjnl-2012-303105  

11 Pereira H , Teles RC , Costa M , da Silva PC , Ferreira RC , da Gama Ribeiro V , et al., Registo Nacional de Cardiologia de Intervenc¸ão. Evolução da intervenção coronária percutânea entre 2004‐2013. Atividade em Portugal segundo o Registo Nacional de Cardiologia de Intervenção [Trends in percutaneous coronary intervention from 2004 to 2013 according to the Portuguese National Registry of Interventional Cardiology]. Rev Port Cardiol. 2015;34(11):673–81. English, Portugese. doi:.https://doi.org/10.1016/j.repc.2015.06.005  

12 Cid Álvarez AB , Rodríguez Leor O , Moreno R , Pérez de Prado A . Spanish Cardiac Catheterization and Coronary Intervention Registry. 27th Official Report of the Spanish Society of Cardiology Working Group on Cardiac Catheterization and Interventional Cardiology (1990-2017). Rev Esp Cardiol (Engl Ed). 2018;71(12):1036–46. doi:.https://doi.org/10.1016/j.rec.2018.09.009  

Notes

*

Contributed equally to the manuscript

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.