Author + information
- Andras Durko1,
- Ruben L.J. Osnabrugge2,
- Nicolas Van Mieghem3,
- Milan Milojevic4,
- Darren Mylotte5 and
- A. Pieter Kappetein6
- 1Erasmus Medical Center, Rotterdam, Netherlands
- 2Erasmus University Medical Center, Rotterdam, Netherlands
- 3Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
- 4Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, Netherlands
- 5Galway University Hospital, Galway, Galway, Ireland
- 6Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, Netherland
The number of transcatheter aortic valve replacement (TAVR) procedures is rapidly increasing. This has a major impact on healthcare resource planning. However, the annual numbers of TAVR candidates per country are unknown. The objective of this study is to provide an up-to-date estimate of the potential number of annual TAVR candidates in 27 European countries, the United States and Canada.
Systematic literature searches and meta-analyses were performed on AS epidemiology and decision-making in severe symptomatic AS. The incidence rate of severe AS was determined. Findings were integrated into a model employing Monte Carlo simulations to predict the annual number of TAVR candidates. Various future scenarios and sensitivity analyses were explored.
Data from 37 studies (n=26,402) informed the model. The calculated incidence rate of severe AS was 4.4‰/year (95% confidence interval [CI]: 3.0‰ – 6.1‰) in patients ≥65 years. AS-related symptoms were present in 68.3% (95% CI: 60.8% to 75.9%) of patients with severe AS. Despite having severe symptomatic AS, 41.6% (95% CI: 36.9% to 46.3%) did not undergo surgical aortic valve replacement. Of the non-operated patients, 61.7% (95% CI: 42.0% to 81.7%) received TAVR. The model predicted 58,556 (95% CI: 35,631 to 87,738) Northern-American and 114,757 (95% CI: 69,380 to 172,799) European TAVR candidates annually.
Approximately 180,000 patients can be considered potential TAVR candidates in Northern-America and in the European Union annually. These numbers increase dramatically if indications for TAVR will expand to low-risk patients.
STRUCTURAL: Valvular Disease: Aortic