Clinical Research
Heart Valve Disease
Transcatheter Aortic Valve Replacement in Europe: Adoption Trends and Factors Influencing Device Utilization

https://doi.org/10.1016/j.jacc.2013.03.074Get rights and content
Under an Elsevier user license
open archive

Objectives

The authors sought to examine the adoption of transcatheter aortic valve replacement (TAVR) in Western Europe and investigate factors that may influence the heterogeneous use of this therapy.

Background

Since its commercialization in 2007, the number of TAVR procedures has grown exponentially.

Methods

The adoption of TAVR was investigated in 11 European countries: Germany, France, Italy, United Kingdom, Spain, the Netherlands, Switzerland, Belgium, Portugal, Denmark, and Ireland. Data were collected from 2 sources: 1) lead physicians submitted nation-specific registry data; and 2) an implantation-based TAVR market tracker. Economic indexes such as healthcare expenditure per capita, sources of healthcare funding, and reimbursement strategies were correlated to TAVR use. Furthermore, we assessed the extent to which TAVR has penetrated its potential patient population.

Results

Between 2007 and 2011, 34,317 patients underwent TAVR. Considerable variation in TAVR use existed across nations. In 2011, the number of TAVR implants per million individuals ranged from 6.1 in Portugal to 88.7 in Germany (33 ± 25). The annual number of TAVR implants performed per center across nations also varied widely (range 10 to 89). The weighted average TAVR penetration rate was low: 17.9%. Significant correlation was found between TAVR use and healthcare spending per capita (r = 0.80; p = 0.005). TAVR-specific reimbursement systems were associated with higher TAVR use than restricted systems (698 ± 232 vs. 213 ± 112 implants/million individuals ≥75 years; p = 0.002).

Conclusions

The authors' findings indicate that TAVR is underutilized in high and prohibitive surgical risk patients with severe aortic stenosis. National economic indexes and reimbursement strategies are closely linked with TAVR use and help explain the inequitable adoption of this therapy.

Key Words

aortic stenosis
transcatheter aortic valve implantation
transcatheter aortic valve replacement

Abbreviations and Acronyms

CE
Conformité Européenne
DRG
diagnosis-related group
GDP
gross domestic product
TAVR
transcatheter aortic valve replacement

Cited by (0)

Dr. Windecker has received institutional research grants from Abbott Vascular, Biotronik, Biosensors, Boston Scientific, Cordis, Medtronic, Edwards Lifesciences, and St. Jude Medical; and lecture fees from Edwards Lifesciences and Medtronic. Dr. Lefèvre has served as a proctor for Edwards Lifesciences; and received minor fees from Directflow and Boston Scientific. Dr. Jeger has received travel cost reimbursements from Edwards Lifesciences and Medtronic. Dr. Wenaweser has served as a proctor for and has received honoraria from Medtronic and Edwards Lifesciences; and has served as a consultant for Biotronik. Dr. Maisano has served as a consultant for Abbott Vascular, Medtronic, St. Jude Medical, and Valtech Cardio; is a founder of 4Tech; and has received royalties from Edwards Lifesciences. Drs. Søndergaard and Piazza have served as proctors and consultants for Medtronic. Dr. Bosmans has served as a proctor for Medtronic. Dr. Teles has served as a consultant for Medtronic; and has received research grants from Boston Scientific. Dr. Manoharan has served as a proctor and consultant for Medtronic and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.