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Implementation of TAVR in France
Study Questions:
What is the number of aortic valve replacements (AVRs) performed in France, changes over time, and the effect of the adoption of transcatheter aortic valve replacement (TAVR)?
Methods:
The investigators collected all consecutive AVRs performed in France between 2007 and 2015 based on a French administrative hospital-discharge database. Trends in patients’ characteristics and outcome over time were estimated by the Mann-Kendall trend test.
Results:
A total of 131,251 interventions were performed: 109,317 (83%) surgical AVR (SAVR) and 21,934 (17%) TAVR. AVR linearly increased (from 10,892 to 18,704; p for trend < 0.0001), mainly due to a marked increase in TAVR (from 244 to 6,722; p for trend = 0.0004), whereas SAVR remained stable (from 10,892 to 11,982; p for trend = 0.18). Parallel to a decrease in the Charlson index (p for trend < 0.05), SAVR and TAVR in-hospital mortality rates significantly declined (both p for trend < 0.01). The number of TAVRs significantly increased in all age categories (<75, 75-79, 80-84, and ≥85 years of age; all p for trend = 0.003), but reached or even exceeded SAVR in the two oldest categories. Although mortality rates declined for both isolated SAVR and TAVR, it became similar or slightly lower for TAVR than for isolated SAVR in 2015 in the three oldest age categories even if it did not reach statistical significance (p = 0.66, p = 0.47, and p = 0.06, respectively).
Conclusions:
The authors concluded that the number of AVRs markedly increased in France between 2007 and 2015 due to the wide adoption of TAVR, which represented one-third of all AVRs in 2015.
Perspective:
This study reports a linear increase in the number of AVRs performed in France, mainly related to the rapid development and widespread diffusion of TAVR, which represented approximately one-third of all AVRs performed in 2015, whereas SAVR remained relatively stable. Furthermore, among patients aged ≥75 years, the in-hospital mortality rate of TAVR was similar or slightly lower than the mortality rate of isolated SAVR despite an overall worse clinical profile. Additional studies are indicated to assess long-term outcomes of TAVR, including the longevity of prosthetic materials and the consequences and management of their degeneration over time as TAVR becomes the first-line therapy for patients with symptomatic aortic stenosis irrespective of age or surgical risk.
Keywords: Aortic Valve Stenosis, Cardiovascular Surgical Procedures, Geriatrics, Heart Valve Diseases, Heart Valve Prosthesis, Hospital Mortality, Outcome Assessment, Health Care, Risk, Secondary Prevention, Transcatheter Aortic Valve Replacement
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