Implementation of Transcatheter Aortic Valve Replacement in France

Nguyen, Virginia; Michel, Morgane; Eltchaninoff, Hélène; Gilard, Martine; Dindorf, Christel; Iung, Bernard; Mossialos, Elías; Cribier, Alain; Vahanian, Alec; Chevreul, Karine; Messika–Zeitoun, David

doi:10.1016/j.jacc.2018.01.079

Cited by 74 publications

(48 citation statements)

References 31 publications

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“…As in large registries from other countries,26 27 the number of TAVI procedures increased significantly, with a total of 29 470 TAVI procedures in 2015 and 2016 alone. In 2016, 98.70% of all procedures were performed in centres with more than 50 procedures per year.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany

Oettinger

Kaier

Heidt

et al. 2020

Heart

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ObjectiveTranscatheter aortic valve implantation (TAVI) is the most common aortic valve replacement in Germany. Since 2015, to ensure high-quality procedures, hospitals in Germany and other countries that meet the minimum requirement of 50 interventions per centre are being certified to perform TAVI. This study analyses the impact of these requirements on case number and in-hospital outcomes.MethodsAll isolated TAVI procedures and in-hospital outcomes between 2008 and 2016 were identified by International Classification of Diseases (ICD) and the German Operation and Procedure Classification codes.Results73 467 isolated transfemoral and transapical TAVI procedures were performed in Germany between 2008 and 2016. During this period, the number of TAVI procedures per year rose steeply, whereas the overall rates of hospital mortality and complications declined. In 2008, the majority of procedures were performed in hospitals with fewer than 50 cases per year (54.63%). Until 2014, the share of patients treated in low-volume centres constantly decreased to 5.35%. After the revision of recommendations, it further declined to 1.99%. In the 2 years after the introduction of the minimum requirements on case numbers, patients were at decreased risk for in-hospital mortality when treated in a high-volume centre (risk-adjusted OR 0.62, p=0.012). The risk for other in-hospital outcomes (stroke, permanent pacemaker implantation and bleeding events) did not differ after risk adjustment (p=0.346, p=0.142 and p=0.633).ConclusionA minimum volume of 50 procedures per centre and year appears suitable to allow for sufficient routine and thus better in-hospital outcomes, while ensuring nationwide coverage of TAVI procedures.

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Section: Discussionmentioning

confidence: 99%

Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany

Oettinger

Kaier

Heidt

et al. 2020

Heart

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“…Guidelines recommend TAVR for patients with severe aortic valve stenosis at increased operative risk . In many countries, TAVR is the most common approach for patients over 75 years with aortic valve stenosis, providing convincing postoperative results . The availability of TAVR led to a shift of high risk patients from SAVR toward TAVR, resulting in a decrease of EuroSCORE in patients with aortic stenosis undergoing SAVR over the last years.…”

Section: Discussionmentioning

confidence: 99%

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Stachon

Kaier

Heidt

et al. 2019

Cathet Cardio Intervent

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Background Transcatheter aortic valve replacement (TAVR) is routinely used in patients with severe aortic stenosis at increased operative risk. Due to potential technical difficulties, TAVR is not recommended for pure aortic regurgitation (AR). Smaller studies reported its use in AR, but data from big registries are lacking. The present study analyzes the nationwide use of surgical aortic valve replacement (SAVR) and TAVR in patients with AR from 2008 until 2015. Methods We identified 138,237 cases of aortic valve replacement in Germany based on ICD and OPS codes. Results Of 13.2% SAVR‐cases and 1.3% of TAVR cases were performed in AR. AR patients undergoing SAVR were younger with lower logistic EuroSCORE (stenosis: 6.1 ± 5.6; AR: 4.5 ± 4.9). Nevertheless, stroke rates, bleedings, prolonged mechanical ventilation, and in‐hospital mortality were higher (mortality: stenosis 2.6%, AR: 4.7%). In the TAVR group, patients with AR were at higher operative risk (logistic EuroSCORE: transfemoral (TF)‐TAVR: stenosis: 14.3 ± 10.4; AR: 17.3 ± 13.3. Transapical (TA)‐TAVR: stenosis: 16.1 ± 11.4; AR: 15.7 ± 12.2). Stroke rates were lower, but bleedings and prolonged ventilation occurred more frequently after TF‐TAVR in AR compared to stenosis. The mortality varied markedly (TF‐TAVR: 15.2% in 2011; 2.8% in 2015; TA‐TAVR: 17.7% in 2012 and 0% in 2014). Conclusion TAVR is off‐label used in AR in clinical practice. TAVR seems to be a safe option for AR with regard to in‐hospital outcomes. However, further research evaluating long‐term outcomes is required to establish the feasibility of TAVR in pure AR.

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“…Tal como fue observado en este registro, el implante percutáneo de la válvula aórtica, produce un benefi cio en la sobrevida y en la calidad de vida de los pacientes, mejorando la evolución natural de esta patología 1,2,20,21 . Este benefi cio no solo se da por un incremento del acceso al tratamiento de pacientes portadores de esta patología con imposibilidad de la resolución quirúrgica, sino también por mejoría de los resultados en pacientes sometidos a reemplazo convencional, debido a una mejor selección del paciente y a una derivación más precoz respecto del curso de la enfermedad 27 . A pesar de un peor perfi l clínico, el implante percutáneo de válvula aórtica presenta una menor tasa de mortalidad comparada con la cirugía convencional en pacientes de 75 años o mayores 27 .…”

Section: Discussionunclassified

“…Este benefi cio no solo se da por un incremento del acceso al tratamiento de pacientes portadores de esta patología con imposibilidad de la resolución quirúrgica, sino también por mejoría de los resultados en pacientes sometidos a reemplazo convencional, debido a una mejor selección del paciente y a una derivación más precoz respecto del curso de la enfermedad 27 . A pesar de un peor perfi l clínico, el implante percutáneo de válvula aórtica presenta una menor tasa de mortalidad comparada con la cirugía convencional en pacientes de 75 años o mayores 27 . Nuestros resultados podrían tener implicancia para el tratamiento de esta patología en nuestro país.…”

Section: Discussionunclassified

Experiencia de implante percutáneo de la válvula aórtica en pacientes con estenosis aórtica severa descartados de cirugía convencional por alto riesgo quirúrgico en una comunidad rural

Blanco¹,

Intervencionista.²,

Blanco³

et al. 2019

RACI

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Introducción. El reemplazo valvular aórtico quirúrgico es el tratamiento de elección en la estenosis aórtica severa sintomática. Ocasionalmente la edad avanzada y las comorbilidades imposibilitan la cirugía donde el reemplazo valvular percutáneo representa una alternativa válida. Objetivo. Comunicar la experiencia del reemplazo percutáneo de la válvula aórtica en pacientes con estenosis aórtica severa y descartados de cirugía convencional por alto riesgo en una comunidad rural. Material y métodos. Registro de 29 pacientes consecutivos con estenosis aórtica severa (área ≤1 cm2) sintomática y riesgo quirúrgico elevado sometidos a implante percutáneo entre el 01/12/2016 al 31/03/2018, utilizando una estrategia multidisciplinaria que involucró a diversos especialistas que conformaban el heart team. Se evaluaron las características basales de los pacientes, resultados del procedimiento, tipo de anestesia utilizada, sintomatología e internaciones en la evolución, y mortalidad al 01/04/2018.

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Implementation of Transcatheter Aortic Valve Replacement in France

Cited by 74 publications

References 31 publications

Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany

Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany

Nationwide outcomes of aortic valve replacement for pure aortic regurgitation in Germany 2008–2015

Experiencia de implante percutáneo de la válvula aórtica en pacientes con estenosis aórtica severa descartados de cirugía convencional por alto riesgo quirúrgico en una comunidad rural

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