Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization

Mylotte, Darren; Osnabrugge, Ruben L. J.; Windecker, Stephan; Lefèvre, Thierry; de Jaegere, Peter; Jeger, Raban; Wenaweser, Peter; Maisano, Francesco; Moat, Neil; Søndergaard, Lars; Bosmans, Johan; Teles, Rui C.; Martucci, Giuseppe; Manoharan, Ganesh; Garcia, Eulogio; Van Mieghem, Nicolas M.; Kappetein, A. Pieter; Serruys, Patrick W.; Lange, Ruediger and Piazza, Nicolo (2013). Transcatheter aortic valve replacement in Europe: adoption trends and factors influencing device utilization. Journal of the American College of Cardiology, 62(3), pp. 210-219. Elsevier 10.1016/j.jacc.2013.03.074

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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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology

UniBE Contributor:

Windecker, Stephan and Wenaweser, Peter Martin


600 Technology > 610 Medicine & health








Judith Liniger

Date Deposited:

21 Mar 2014 08:21

Last Modified:

28 Oct 2015 11:47

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

aortic stenosis; transcatheter aortic valve implantation; transcatheter aortic valve replacement




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