Study Analyzes Implementation of TAVR in France
April 10, 2018—Findings from a study of the implementation of transcatheter aortic valve replacement (TAVR) procedures in France were published by Virginia Nguyen, MD, et al in Journal of the American College of Cardiology (JACC; 2018;71:1614–1627). The 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 as it emerged as an alternative to surgical aortic valve replacement (SAVR).
As summarized in JACC, the study collected data on all consecutive AVRs performed in France between 2007 and 2015 based on a French administrative hospital-discharge database.
In this period, a total of 131,251 interventions were performed: 109,317 (83%) SAVRs and 21,934 (17%) TAVRs. AVR linearly increased (from 10,892 to 18,704; P for trend < .0001), mainly because of an increase in TAVR (from 244 to 6,722; P for trend = .0004), whereas SAVR remained stable (from 10,892 to 11,982; P for trend = .18).
Parallel to a decrease in the Charlson index (P for trend < .05), SAVR and TAVR in-hospital mortality rates significantly declined (in both, P for trend < .01). The number of TAVRs significantly increased in all age categories (< 75, 75–79, 80–84, and ≥ 85 years of age; in all, P for trend = .003) but reached or even exceeded SAVR in the two oldest patient 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 patient age categories, even if it did not reach statistical significance (P = .66; P = .47; and P = .06; respectively).
The investigators concluded that the number of AVRs markedly increased in France between 2007 and 2015 because of the wide adoption of TAVR, which represented one-third of all AVRs in 2015. Patients' profiles 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 older than 75 years. The results may have major implications for clinical practice and policymakers, advised the investigators in JACC.