Choice of Treatment for Aortic Valve Stenosis in the Era of Transcatheter AorticValve Replacement in EasternDenmark (2005 to 2015).

Abstract

The aim of this study was to evaluate the choice of treatment for severe aortic valve stenosis in the era oftranscatheter aortic valve replacement (TAVR) in Eastern Denmark. Until the early 21st century, the only therapeutic option for aortic valve stenosis was surgical aortic valve replacement (SAVR), but this has changed with the introduction of TAVR. Using the East Denmark Heart Registry, the evolution of AVR over time was studied for the period 2005to2015. TAVR has since its introduction in 2007 seen steady growth, with currently more than 35% of AVR procedures-and 45% of isolated AVR procedures-being performed by transcatheter-based technology. The number of SAVR procedures remained rather stable over the study period and even saw a slight decline since 2012-there was a marked decrease in the age at which surgical bioprostheses are considered appropriate. The age profile of TAVR patients remained unchanged over the study period, with a recent trend toward more low- and intermediate-risk patients. Currently, patients age ≥80 years and/or with a Society of Thoracic Surgeons (STS) surgical risk score >6 are automatically referred for TAVR, and one-half of patients age 70 to 80 years with an STS risk score of 4 to 6 are treated withTAVR. The number of TAVR procedures has increased steadily in recent years, with a TAVR penetration rateof35% in 2015 and close to 45% when considering isolated AVR. The number of SAVR procedures remained stableover the study period, and surgical bioprostheses are currently used at a much younger age than in2005.