Summary of California-wide Trends in Cardiac Procedures - Volume

After a peak of over 93,500 cardiac procedures in 2002, procedure volume has decreased by 22% to under 73,500 cardiac procedures in 2013. For 2014 through 2019, the cardiac procedure volume increased each year. COVID-19 likely led to a decrease in cardiac surgeries in 2020: Compared to 2019, the volume of cardiac surgeries decreased by 14% in 2020 and remained under the 2015 volume. In 2021, the volume of cardiac surgeries recovered somewhat, but was still 8% lower compared to 2019.

For the Cardiac Procedure Volume chart below, the group of valve surgeries is comprised of Surgical Aortic or Mitral Valve Replacements, Surgical Mitral Valve Repairs, Multiple Surgical Valve procedures including 2 or more of these procedures, Transcatheter Aortic or Mitral Valve Replacements and Transcatheter Mitral Valve Repairs. Other Cardiac Surgeries include other valve procedures (e.g., tricuspid or pulmonic valve procedures) that are not performed with an aortic/mitral valve replacement or mitral valve repair, non-isolated procedures, and other cardiac surgeries that require ECC (e.g., heart transplants).

Isolated Surgical AV/MV with or without CABG or Transcatheter AV/MV includes: Isolated Surgical Aortic Valve Replacement, Surgical Mitral Valve Replacement, Isolated Surgical Mitral Valve Repair each done with or without CABG and Transcatheter Aortic Valve Replacement, Mitral Valve Replacment, and Mitral Valve Repairs. Non-isolated aortic and mitral valve replacments or mitral valve repairs, other valve procedures, and other cardiac surgeries performed using ECC are included in Other Cardiac Surgery.
For additional information on isolated vs non-isolated surgery, please review FAQ Section 6 and FAQ Section 7.

The percentage of Percutaneous Coronary Interventions (PCIs) went from 57% of all cardiac procedures in 1999 to almost 70% in 2006. While the percentage of PCIs remained around 69% through 2010, the percentage decreased for most years since 2010. In 2021, 62% of all cardiac procedures were PCIs.

Through 2011, among PCIs only, most PCIs performed were PCIs without ACS compared to PCIs with ACS (with an acute MI diagnosis at the time of the procedure). Each year starting from 2012, more PCIs with ACS were performed than PCIs without ACS.

In more recent years, PCIs were more frequently performed in an ambulatory surgery (AS) setting: In 2005, the year for which ambulatory surgery data for AS centers associated with CA licensed acute care hospitals were first available, 1.9% of PCIs were performed in an AS setting compared to 24% in 2021. PCIs in the emergency room went from 0.03% of all PCIs in 2005 to 1.2% in 2021. Most of the PCIs performed in an ambulatory surgery setting in 2021 were PCIs without ACS (90%). The percentage of outpatient PCIs across hospitals ranged from 0 to 100% in 2021 with a mean and median percentage of 15% and 8% respectively.

Regarding PCI volumes reported on this website, since release of the CCSIP reports in early May of 2014, we have realized that some health facilities might under-report outpatient PCIs. For more details on this issue, please review Why do the PCI volumes reported for a facility differ from volumes reported by other data sources?.

The volume of isolated CABG procedures decreased steadily from 2000 through 2012. Compared to the year 2000 which saw a peak of over 28,000 CABG procedures, a volume just short of 12,000 isolated CABG procedures was performed in 2012, a 55% decrease. In 2013 through 2019, the volume of isolated CABG surgeries fluctuated between 12,000 and 13,000 procedures per year. In 2020, the volume of isolated CABG procedures decreased to under 11,000, just under 12,000 isolated CABG procedures were done in 2021.

Isolated Surgical AV/MV with or without CABG or Transcatheter AV/MV includes: Isolated Surgical Aortic Valve Replacement, Surgical Mitral Valve Replacement, Isolated Surgical Mitral Valve Repair each done with or without CABG and Transcatheter Aortic Valve Replacement, Mitral Valve Replacment, and Mitral Valve Repairs. Non-isolated aortic and mitral valve replacments or mitral valve repairs, other valve procedures, and other cardiac surgeries performed using ECC are included in Other Cardiac Surgery.
For additional information on isolated vs non-isolated surgery, please review FAQ Section 6 and FAQ Section 7.

The Valve Procedure volume chart below breaks down the group of valve procedures into isolated Surgical Aortic Valve Replacements, isolated Surgical Mitral Valve Replacements, and isolated Surgical Mitral Valve Repairs, or multi-valve surgeries including these surgical valve procedures with or without a CABG procedure. Also shown are Transcatheter Aortic Valve Replacements (TAVR), Transcatheter Mitral Valve Replacements, Transcatheter Mitral Valve Repairs, all other surgical valve procedures and other transcatheter valve procedures, e.g., pulmonic or tricuspid valve procedures.

The volume of all valve procedures increased from just under 9,000 in 1999 to almost 17,000 in 2019. Since 2012, this growth is supported primarily by the increasing use of TAVRs. The volume of valve procedures decreased by 8% in 2020, a considerably smaller reduction compared to all cardiac procedures. In 2021, the valve procedure volume had almost recovered to the 2019 level. The volume of Surgical Aortic Valve Replacments has decreased every year since 2013, presumably as surgeons increasingly preferred transcatheter to surgical aortic valve replacements. In 2021, 84% of all aortic valve replacements and 48% of all valve procedures were TAVRs.

With the exception of the Other Surgical Valves and Other Transcatheter Valves groups, all valve surgeries are isolated surgeries, in other words, no major other cardiac surgery was performed on the same date as the valve surgery. For additional information on isolated vs non-isolated surgery, please review FAQ Section 7.
Prior to 2009, it was not possible to identify transcatheter mitral valve repair or replacements using the ICD-9-PCS coding system. Prior to 2011, it was not possible to identify transcatheter aortic valve replacements using the ICD-9-PCS coding system.
With the exception of the Other Surgical Valves and Other Transcatheter Valves groups, all valve surgeries are isolated surgeries, in other words, no major other cardiac surgery was performed on the same date as the valve surgery. For additional information on isolated vs non-isolated surgery, please review FAQ Section 7.
Prior to 2009, it was not possible to identify transcatheter mitral valve repair or replacements using the ICD-9-PCS coding system. Prior to 2011, it was not possible to identify transcatheter aortic valve replacements using the ICD-9-PCS coding system.