Author + information
- Received October 20, 2017
- Revision received December 30, 2017
- Accepted January 30, 2018
- Published online April 9, 2018.
- Virginia Nguyen, MD, PhDa,b,c,
- Morgane Michel, MD, PhDc,d,e,
- Helene Eltchaninoff, MDf,
- Martine Gilard, MDg,
- Christel Dindorf, MScc,d,e,
- Bernard Iung, MDa,b,c,
- Elias Mossialos, BSc, MD, PhDh,
- Alain Cribier, MDf,
- Alec Vahanian, MDa,b,c,
- Karine Chevreul, MD, PhDc,d,e and
- David Messika-Zeitoun, MD, PhDa,b,c,∗ ()
- aDepartment of Cardiology, Assistance Publique-Hôpitaux de Paris, Bichat Hospital, Paris, France
- bINSERM U1148, Bichat Hospital, Paris, France
- cUniversité Paris Diderot, Sorbonne Paris Cité, Paris, France
- dURC Eco Ile de France, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France
- eINSERM, ECEVE, U1123, Paris, France
- fRouen University Hospital, INSERM U1096, FHU REMOD-VHF, Rouen, France
- gDepartment of Cardiology, Brest University Hospital, Brest, France
- hLSE Health, London School of Economics & Political Science, London, United Kingdom
- ↵∗Address for correspondence:
Dr. David Messika-Zeitoun, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario K1Y 4W7, Canada.
Background 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.
Objectives 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.
Methods Based on a French administrative hospital-discharge database, the study collected all consecutive AVRs performed in France between 2007 and 2015.
Results 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).
Conclusions 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.
The present study was partially funded by the RHU STOP AS. Dr. Nguyen was supported by a grant from the Société Française de Cardiologie and the Fédération Française de Cardiologie. Dr. Eltchaninoff has served as a proctor for and received lecture fees from Edwards Lifesciences. Dr. Iung has received speaker fees from Edwards Lifesciences. Dr. Cribier has served as a consultant for Edwards Lifesciences. Dr. Vahanian has served as a consultant for Edwards Lifesciences, Abbott Vascular, and Mitraltech. Dr. Messika-Zeitoun has served as a consultant for Edwards Lifesciences, Mardil, and Cardiawave; and has received research grants from Edwards Lifesciences and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 20, 2017.
- Revision received December 30, 2017.
- Accepted January 30, 2018.
- 2018 American College of Cardiology Foundation
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