Table of Contents

1. OVERVIEW OF CARDIOVASCULAR/THORACIC DISEASES/DISORDERS…………………………………………………1-1
1.1 Aneurysm ……………………………………………………………………………… 1-4
1.2 Angina Pectoris ……………………………………………………………………… 1-5
1.3 Arrhythmia …………………………………………………………………………….. 1-6
1.4 Atherosclerosis………………………………………………………………………. 1-6
1.5 Heart Failure………………………………………………………………………….. 1-7
1.6 Heart Valve Disease……………………………………………………………….. 1-8
1.7 Hypercholesterolemia and Hypertension……………………………………. 1-9
1.8 Myocardial Infarction …………………………………………………………….. 1-10
1.9 Peripheral Artery Disease………………………………………………………. 1-10
Exhibit 1-1: Cardiovascular/Thoracic Surgery, Procedure Volumes Forecast,
by Type, 2011-2017………………………………………………………………… 1-2
Exhibit 1-2: Cardiovascular/Thoracic Diseases/Disorders,
Hospital Discharges and Prevalence……………………………………….. 1-12
2. CARDIOVASCULAR DISEASES/DISORDERS…………………………………… 2-1
2.1 Atherosclerosis………………………………………………………………………. 2-1
2.1.1 Coronary Atherosclerosis ………………………………………….. 2-2
2.1.1.1 Etiology ……………………………………………………. 2-2
2.1.1.2 Epidemiology…………………………………………….. 2-4
2.1.2 Peripheral Artery Disease………………………………………….. 2-5
2.1.2.1 Etiology ……………………………………………………. 2-5
2.1.2.2 Epidemiology…………………………………………….. 2-5
2.2 Heart Failure………………………………………………………………………….. 2-7
2.2.1 Etiology…………………………………………………………………… 2-7
2.2.2 Epidemiology…………………………………………………………. 2-10
2.3 Hypercholesterolemia……………………………………………………………. 2-11
2.3.1 Etiology…………………………………………………………………. 2-11
2.3.2 Epidemiology…………………………………………………………. 2-13
2.4 Hypertension ……………………………………………………………………….. 2-14
2.4.1 Etiology…………………………………………………………………. 2-14
2.4.2 Epidemiology…………………………………………………………. 2-18
2.5 Ischemic Heart Disease…………………………………………………………. 2-19
2.5.1 Angina Pectoris ……………………………………………………… 2-19
2.5.1.1 Etiology ………………………………………………….. 2-20
2.5.1.2 Epidemiology…………………………………………… 2-20
2.5.2 Myocardial Infarction ………………………………………………. 2-22
2.5.2.1 Etiology ………………………………………………….. 2-22
2.5.2.2 Epidemiology…………………………………………… 2-24
2.6 Metabolic Syndrome……………………………………………………………… 2-24
2.6.1 Etiology…………………………………………………………………. 2-25
2.6.2 Epidemiology…………………………………………………………. 2-25
2.7 Pacing Disorders ………………………………………………………………….. 2-27
2.7.1 Arrhythmia…………………………………………………………….. 2-28
2.7.1.1 Etiology ………………………………………………….. 2-28
2.7.1.2 Epidemiology…………………………………………… 2-31
2.7.2 Sudden Cardiac Death ……………………………………………. 2-35
2.7.2.1 Etiology ………………………………………………….. 2-37
2.7.2.2 Epidemiology…………………………………………… 2-38
2.8 Valvular Heart Disease………………………………………………………….. 2-39
2.8.1 Etiology…………………………………………………………………. 2-39
2.8.2 Epidemiology…………………………………………………………. 2-42
Exhibit 2-1: Coronary Atherosclerosis, Facts and Figures,
1999-2009, and 2011 ……………………………………………………………… 2-3
Exhibit 2-2: Peripheral Artery Disease, Facts and Figures,
1999-2009, and 2011 ……………………………………………………………… 2-6
Exhibit 2-3: Heart Failure, Facts and Figures, Selected Years 1999-2011……….. 2-8
Exhibit 2-4: Hypercholesterolemia, Facts and Figures, 1999-2009,
and 2011 …………………………………………………………………………….. 2-12
Exhibit 2-5: Hypertension, Facts and Figures, 1999-2009, and 2011…………….. 2-15
Exhibit 2-6: Angina Pectoris, Facts and Figures, 1999-2009, and 2011…………. 2-21
Exhibit 2-7: Myocardial Infarction, Facts and Figures, 1999-2009, and 2011….. 2-23
Exhibit 2-8: Metabolic Syndrome, Facts and Figures, 2005-2009, and 2011 ….. 2-26
Exhibit 2-9: Arrhythmia, Facts and Figures, 1999-2009, and 2011………………… 2-29
Exhibit 2-10: Tachycardia, Facts and Figures, 1999-2009, and 2011 ……………… 2-32
Exhibit 2-11: 2011, Sudden Cardiac Death, Facts and Figures………………………. 2-36
Exhibit 2-12: Valvular Heart Disease, Facts and Figures, 1999-2009,
and 2011 …………………………………………………………………………….. 2-40
3. CARDIOVASCULAR/THORACIC SURGICAL PROCEDURES …………….. 3-1
3.1 Circulatory Vascular Disorders …………………………………………………. 3-1
3.1.1 Atherosclerosis………………………………………………………… 3-2
3.1.2 Coronary Heart Disease……………………………………………. 3-3
3.1.3 Angina Pectoris ……………………………………………………….. 3-4
3.1.4 Acute Myocardial Infarction ……………………………………….. 3-6
3.1.5 Peripheral Vascular Disease ……………………………………… 3-7
3.1.5.1 Aortic Aneurysm………………………………………… 3-8
3.1.5.2 Lower Extremity Arterial Occlusions……………… 3-9
3.1.5.3 Deep Vein Thrombosis and
Pulmonary Embolism ……………………………….. 3-11
3.2 Myocardial Disorders…………………………………………………………….. 3-13
3.2.1 Congenital Heart Defects ………………………………………… 3-13
3.2.2 Heart Valve Disorders …………………………………………….. 3-16
3.2.3 Heart Failure………………………………………………………….. 3-18
3.3 Cardiac Rhythm Disorders …………………………………………………….. 3-22
3.3.1 Bradycardia …………………………………………………………… 3-23
3.3.2 Supraventricular Tachycardia…………………………………… 3-23
3.3.2.1 Atrial Fibrillation……………………………………….. 3-24
3.3.3 Ventricular Tachycardia…………………………………………… 3-27
3.3.3.1 Ventricular Fibrillation……………………………….. 3-27
3.4 Therapeutic Management of Circulatory Disorders ……………………. 3-28
3.4.1 Coronary Artery Disease Treatment………………………….. 3-29
3.4.1.1 Coronary Artery Bypass Graft Surgery………… 3-29
3.4.1.1.1 Less Invasive Coronary Artery Bypass Graft Surgery…………….. 3-30
3.4.1.1.2 Patient Indications and Outcomes………………………. 3-32
3.4.1.1.3 Procedure Volumes ………………. 3-34
3.4.1.2 Percutaneous Coronary Interventions …………. 3-35
3.4.1.2.1 Percutaneous Transluminal
Coronary Angioplasty and Stenting…………………………. 3-35
3.4.1.2.1.1 Procedure Volumes …………… 3-40
3.4.1.2.2 Mechanical Atherectomy………… 3-41
3.4.1.2.2.1 Procedure Volumes …………… 3-44
3.4.1.2.3 Laser Coronary Atherectomy ….. 3-47
3.4.1.2.3.1 Procedure Volumes …………… 3-47
3.4.1.2.4 Mechanical Coronary Thrombectomy……………………… 3-48
3.4.1.2.4.1 Procedure Volumes …………… 3-50
3.4.1.3 Transmyocardial Laser Revascularization……. 3-52
3.4.1.3.1 Procedure Volumes ………………. 3-54
3.4.2 Peripheral Vascular Disease Treatment…………………….. 3-55
3.4.2.1 Aortic Aneurysm Treatment Regimens………… 3-55
3.4.2.1.1 Surgical Repair of Aortic Aneurysms………………….. 3-55
3.4.2.1.2 Abdominal Aortic Aneurysm Repair/ Endovascular Stent Grafting …… 3-57
3.4.2.1.2.1 Limitations of Endovascular Abdominal AorticAneurysm Repair.. 3-58
3.4.2.1.3 Endovascular Thoracic Aortic
Aneurysm Repair ………………….. 3-59
3.4.2.1.4 Procedure Volumes ………………. 3-60
3.4.2.2 Treatment of Lower Extremity Arterial Occlusions …………………………………… 3-60
3.4.2.2.1 Bypass Graft Surgery for Lower Extremity Revascularization……. 3-60
3.4.2.2.1.1 Aortoiliofemoral Bypass Graft Surgery…….. 3-62
3.4.2.2.1.2 Tibioperoneal Reconstruction…… 3-63
3.4.2.2.1.3 Femoropopliteal Bypass Surgery …. 3-63
3.4.2.2.1.4 Procedure Volumes …………… 3-64
3.4.2.2.2 Percutaneous Transluminal Angioplasty ………………………….. 3-64
3.4.2.2.2.1 Procedure Volumes …………… 3-67
3.4.2.2.3 Lower Extremity Stenting ……….. 3-67
3.4.2.2.3.1 Iliac Artery Stenting ……………. 3-69
3.4.2.2.3.2 Femoropopliteal Artery Stenting…… 3-69
3.4.2.2.3.3 Infrapopliteal/Below-the-Knee Stenting ……………. 3-71
3.4.2.2.3.4 ProcedureVolumes …………… 3-73
3.4.2.2.4 Peripheral Mechanical Atherectomy…………………………. 3-73
3.4.2.2.4.1 Procedure Volumes …………… 3-75
3.4.2.2.5 Peripheral Excimer Laser Atherectomy………………… 3-75
3.4.2.2.5.1 Procedure Volumes …………… 3-77
3.4.2.2.6 Peripheral Mechanical Thrombectomy……………………… 3-78
3.4.2.2.6.1 Procedure Volumes …………… 3-78
3.5 Therapeutic Management of Myocardial Disorders ……………………. 3-80
3.5.1 Congenital Heart Defect Repair………………………………… 3-80
3.5.1.1 Procedure Volumes………………………………….. 3-83
3.5.2 Therapeutic Management of Heart Valve Disorders…….. 3-83
3.5.2.1 Percutaneous Balloon Valvuloplasty …………… 3-85
3.5.2.1.1 Procedure Volumes ………………. 3-86
3.5.2.2 Heart Valve Repair and Replacement …………. 3-87
3.5.2.2.1 Procedure Volumes ………………. 3-89
3.5.3 Ventricular Assist Devices for Late-Stage Heart Failure………………………………………………………….. 3-91
3.5.3.1 Procedure Volumes………………………………….. 3-96
3.6 Implantable Devices for Cardiac Rhythm Management………………. 3-96
3.6.1 Cardiac Pacing Systems …………………………………………. 3-98
3.6.1.1 Magnetic Resonance Imaging-Safe Pacemakers ………………………… 3-99
3.6.1.2 Procedure Volumes………………………………… 3-100
3.6.2 Implantable Cardioverter Defibrillators …………………….. 3-101
3.6.2.1 Procedure Volumes………………………………… 3-103
3.6.3 Cardiac Resynchronization Therapy Systems…………… 3-104
3.6.3.1 Procedure Volumes………………………………… 3-107
3.7 Thoracic Surgery ………………………………………………………………… 3-108
3.7.1 Thoracotomy ……………………………………………………….. 3-110
3.7.2 Thoracoscopy………………………………………………………. 3-111
Exhibit 3-1: On-Pump and Off-Pump Coronary Artery Bypass Graft Surgery,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-36
Exhibit 3-2: Percutaneous Transluminal Coronary Angioplasty/Stenting,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-42
Exhibit 3-3: Mechanical Coronary Atherectomy,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-46
Exhibit 3-4: Laser Coronary Atherectomy, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-49
Exhibit 3-5: Mechanical Coronary Thrombectomy,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-53
Exhibit 3-6: Transmyocardial Laser Revascularization,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-56
Exhibit 3-7: Aortic Aneurysm Repair, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-61
Exhibit 3-8: Lower Extremity Surgical Bypass Grafting,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-65
Exhibit 3-9: Percutaneous Transluminal Angioplasty,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-68
Exhibit 3-10: Lower Extremity Stenting, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-74
Exhibit 3-11: Peripheral Mechanical Atherectomy,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-76
Exhibit 3-12: Peripheral Excimer Laser Atherectomy,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-79
Exhibit 3-13: Peripheral Mechanical Thrombectomy,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-81
Exhibit 3-14: Clinical Presentation and Share of Common Congenital
Heart Defects ………………………………………………………………………. 3-82
Exhibit 3-15: Congenital Heart Defect Repair, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………… 3-84
Exhibit 3-16: Percutaneous Balloon Valvuloplasty,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-88
Exhibit 3-17: Heart Valve Repair and Replacement,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-92
Exhibit 3-18: Ventricular Assist Device Placement,
Procedure Volumes Forecast, 2011-2017 ………………………………… 3-97
Exhibit 3-19: Pacemaker Implantation, Procedure Volumes Forecast,
2011-2017 …………………………………………………………………………. 3-102
Exhibit 3-20: Implantable Cardioverter Defibrillator Placement,
Procedure Volumes Forecast, 2011-2017 ………………………………. 3-105
Exhibit 3-21: Cardiac Resynchronization Therapy Device Placement,
Procedure Volumes Forecast, 2011-2017 ………………………………. 3-109
Exhibit 3-22: Thoracotomy, Procedure Volumes Forecast, 2011-2017 ………….. 3-112
Exhibit 3-23: Thoracoscopy, Procedure Volumes Forecast, 2011-2017…………. 3-115