Implementation of Transcatheter Aortic Valve Replacement in France
Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), but unbiased data regarding evolution of the treatment of patients with aortic stenosis at the nationwide level are scarce. This study sought to evaluate the number of aortic valv...
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| Vydáno v: | Journal of the American College of Cardiology Ročník 71; číslo 15; s. 1614 |
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| Médium: | Journal Article |
| Jazyk: | angličtina |
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17.04.2018
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| ISSN: | 1558-3597, 1558-3597 |
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| Abstract | Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), but unbiased data regarding evolution of the treatment of patients with aortic stenosis at the nationwide level are scarce.
This study sought to evaluate the number of aortic valve replacements (AVRs) performed in France, changes over time, and the effect of the adoption of TAVR.
Based on a French administrative hospital-discharge database, the study collected all consecutive AVRs performed in France between 2007 and 2015.
A total of 131,251 interventions were performed: 109,317 (83%) 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 to 79, 80 to 84, and ≥85 years of age; all p for trend = 0.003), but reached or even exceeded SAVR in the 2 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 3 oldest age categories even if it did not reach statistical significance (p = 0.66, p = 0.47, and p = 0.06, respectively).
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. Patients' profile improved, suggesting that patients are referred earlier, and in-hospital mortality declined in all AVR subsets. Despite a worse clinical profile, the immediate outcome of TAVR compared favorably to isolated SAVR in patients >75 years of age. The results may have major implications for clinical practice and policymakers. |
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| AbstractList | Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), but unbiased data regarding evolution of the treatment of patients with aortic stenosis at the nationwide level are scarce.BACKGROUNDTranscatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), but unbiased data regarding evolution of the treatment of patients with aortic stenosis at the nationwide level are scarce.This study sought to evaluate the number of aortic valve replacements (AVRs) performed in France, changes over time, and the effect of the adoption of TAVR.OBJECTIVESThis study sought to evaluate the number of aortic valve replacements (AVRs) performed in France, changes over time, and the effect of the adoption of TAVR.Based on a French administrative hospital-discharge database, the study collected all consecutive AVRs performed in France between 2007 and 2015.METHODSBased on a French administrative hospital-discharge database, the study collected all consecutive AVRs performed in France between 2007 and 2015.A total of 131,251 interventions were performed: 109,317 (83%) 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 to 79, 80 to 84, and ≥85 years of age; all p for trend = 0.003), but reached or even exceeded SAVR in the 2 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 3 oldest age categories even if it did not reach statistical significance (p = 0.66, p = 0.47, and p = 0.06, respectively).RESULTSA total of 131,251 interventions were performed: 109,317 (83%) 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 to 79, 80 to 84, and ≥85 years of age; all p for trend = 0.003), but reached or even exceeded SAVR in the 2 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 3 oldest age categories even if it did not reach statistical significance (p = 0.66, p = 0.47, and p = 0.06, respectively).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. Patients' profile improved, suggesting that patients are referred earlier, and in-hospital mortality declined in all AVR subsets. Despite a worse clinical profile, the immediate outcome of TAVR compared favorably to isolated SAVR in patients >75 years of age. The results may have major implications for clinical practice and policymakers.CONCLUSIONSThe 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. Patients' profile improved, suggesting that patients are referred earlier, and in-hospital mortality declined in all AVR subsets. Despite a worse clinical profile, the immediate outcome of TAVR compared favorably to isolated SAVR in patients >75 years of age. The results may have major implications for clinical practice and policymakers. Transcatheter aortic valve replacement (TAVR) has emerged as an alternative to surgical aortic valve replacement (SAVR), but unbiased data regarding evolution of the treatment of patients with aortic stenosis at the nationwide level are scarce. This study sought to evaluate the number of aortic valve replacements (AVRs) performed in France, changes over time, and the effect of the adoption of TAVR. Based on a French administrative hospital-discharge database, the study collected all consecutive AVRs performed in France between 2007 and 2015. A total of 131,251 interventions were performed: 109,317 (83%) 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 to 79, 80 to 84, and ≥85 years of age; all p for trend = 0.003), but reached or even exceeded SAVR in the 2 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 3 oldest age categories even if it did not reach statistical significance (p = 0.66, p = 0.47, and p = 0.06, respectively). 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. Patients' profile improved, suggesting that patients are referred earlier, and in-hospital mortality declined in all AVR subsets. Despite a worse clinical profile, the immediate outcome of TAVR compared favorably to isolated SAVR in patients >75 years of age. The results may have major implications for clinical practice and policymakers. |
| Author | Dindorf, Christel Eltchaninoff, Helene Gilard, Martine Chevreul, Karine Vahanian, Alec Michel, Morgane Messika-Zeitoun, David Nguyen, Virginia Mossialos, Elias Iung, Bernard Cribier, Alain |
| Author_xml | – sequence: 1 givenname: Virginia surname: Nguyen fullname: Nguyen, Virginia organization: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France – sequence: 2 givenname: Morgane surname: Michel fullname: Michel, Morgane organization: Université Paris Diderot, Sorbonne Paris Cité, Paris, France; URC Eco Ile de France, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France; INSERM, ECEVE, U1123, Paris, France – sequence: 3 givenname: Helene surname: Eltchaninoff fullname: Eltchaninoff, Helene organization: Rouen University Hospital, INSERM U1096, FHU REMOD-VHF, Rouen, France – sequence: 4 givenname: Martine surname: Gilard fullname: Gilard, Martine organization: Department of Cardiology, Brest University Hospital, Brest, France – sequence: 5 givenname: Christel surname: Dindorf fullname: Dindorf, Christel organization: Université Paris Diderot, Sorbonne Paris Cité, Paris, France; URC Eco Ile de France, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France; INSERM, ECEVE, U1123, Paris, France – sequence: 6 givenname: Bernard surname: Iung fullname: Iung, Bernard organization: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France – sequence: 7 givenname: Elias surname: Mossialos fullname: Mossialos, Elias organization: LSE Health, London School of Economics & Political Science, London, United Kingdom – sequence: 8 givenname: Alain surname: Cribier fullname: Cribier, Alain organization: Rouen University Hospital, INSERM U1096, FHU REMOD-VHF, Rouen, France – sequence: 9 givenname: Alec surname: Vahanian fullname: Vahanian, Alec organization: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France – sequence: 10 givenname: Karine surname: Chevreul fullname: Chevreul, Karine organization: Université Paris Diderot, Sorbonne Paris Cité, Paris, France; URC Eco Ile de France, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France; INSERM, ECEVE, U1123, Paris, France – sequence: 11 givenname: David surname: Messika-Zeitoun fullname: Messika-Zeitoun, David email: DMessika-zeitoun@ottawaheart.ca organization: Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France; INSERM U1148, Bichat Hospital, Paris, France; Université Paris Diderot, Sorbonne Paris Cité, Paris, France. Electronic address: DMessika-zeitoun@ottawaheart.ca |
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