Study Shows Effect of Introduction of TAVR on Clinical Practice in Germany

December 17, 2015—In a study funded by the Heart Center at the University of Freiburg in Germany, investigators reported that the use of transcatheter aortic valve replacement (TAVR) increased significantly in Germany between 2007 and 2013, with only a moderate associated reduction in the use of surgical aortic-valve replacement (SAVR). Jochen Reinöhl, MD, et al published the findings in The New England Journal of Medicine (NEJM) (2015;373;2438–2447).

The investigators found that patients undergoing TAVR were older and at higher procedural risk than those undergoing SAVR. In-hospital mortality decreased in both groups, but to a greater extent among patients undergoing TAVR.

According to the investigators, since the adoption of TAVR, questions have been raised about its effect on clinical practice in comparison with the effect of SAVR, which is considered the current standard of care. Complete nationwide data are useful in examining how the introduction of a new technique influences previous clinical standards.

In this study, the investigators analyzed data on characteristics of patients and in-hospital outcomes for all isolated TAVR and surgical aortic-valve replacement procedures performed in Germany from 2007 to 2013.

As summarized in NEJM, there were 32,581 TAVR and 55,992 SAVR procedures performed in this period. The number of TAVR procedures increased from 144 in 2007 to 9,147 in 2013, whereas the number of SAVR procedures decreased slightly, from 8,622 to 7,048. Patients undergoing TAVR were older than those undergoing SAVR (mean age, 81.0 ± 6.1 years vs 70.2 ± 10.0 years). The TAVR patients were at higher preoperative risk (estimated logistic EuroSCORE, 22.4% vs 6.3%).

In-hospital mortality decreased in both groups between 2007 and 2013 (from 13.2% to 5.4% with TAVR and from 3.8% to 2.2% with SAVR). The incidences of stroke, bleeding, and pacemaker implantation (but not acute kidney injury) also declined, reported the investigators in NEJM.