Implant dynamics of transcatheter aortic valve implantation in Europe

Purpose: Transcatheter aortic valve implantation (TAVI) gained Conformité Européenne (CE)-mark approval in 2007, and in subsequent years the number of patients undergoing TAVI in Europe has increased exponentially. Disparate adoption of medical technology is pervasive and results in inequitable patient access. Adoption kinetics of a novel medical technology such as TAVI has not been previously described. We sought to examine the adoption kinetics of TAVI in Western Europe Methods: TAVI adoption was investigated across 11 European nations: Germany, France, Italy, United Kingdom (UK), Spain, The Netherlands, Switzerland, Belgium, Portugal, Denmark and Ireland. Two sources of data were used: (1) lead physicians in each nation provided national registry data; and (2) the European Cardiovascular Monitor system. The penetration of TAVI in each nation was determined as a measure of actual TAVI use relative to potential use. Results: Between January 2007 and December 2011, 34,317 patients underwent TAVI in the 11 study nations. Almost half of all implants were performed in Germany (45.9%). In 2011, the highest annual increase in procedural volume was observed in France (61%) and Germany (49%), while Ireland (-15%) and Portugal (-3%) experienced a decline. We observed a wide variation in the number of TAVI implants per million of population. Germany (88.7) and Portugal (6.1) accounted for the highest and lowest number of TAVI implants per million of population in 2011, respectively. Among the 11 study nations, the mean number of TAVI implants per million was 32.9±24.9. The number of centres performing TAVI increased 9-fold from 37 in 2007 to 342 in 2011. In 2011, Germany (90) and Italy (87) had the highest number of TAVI centres whereas Portugal, Denmark and Ireland (3) had the lowest. Belgium had the highest number of TAVI centres per million (2·1). On average, there were 0·9±0.6 TAVI centres per million. These numbers led to an average of 41±28 TAVI implants per centre in 2011, with estimates in individual countries ranging from 10 in Ireland to 89 in Germany. In 2011, we estimate that there were 28,400 living TAVI recipients and 158,371 potential TAVI candidates in the 11 study nations. Thus, the calculated weighted average TAVI penetration rate was 17.9%. Germany (36.2%) and Portugal had the highest and lowest TAVI penetration rates, respectively. Conclusions: There is substantial variation in the adoption of TAVI and in the annual number of TAVI implants per centre across nations. TAVI remains greatly underutilised with an estimated weighted penetration rate of 17.9%.