Transcatheter aortic valve implantation: the European experience

Abstract

The European transcatheter aortic valve implantation experience began in 2002, and ever since, numerous centers have started a program, resulting in a "transcatheter aortic valve implantation pandemic." Considerable experience has been gained with various access routes for implantation and with valve-in-surgical bioprosthetic valve procedures. Reimbursement differs among the European countries and is currently undergoing rapid changes. Accordingly, the implantation rates in various European countries still differ considerably, with the greatest in Switzerland and Germany: 77 implants per 1 million treatable inhabitants. The Edwards Source and the Medtronic Advance trials, designed as postcommercialization studies, demonstrated a steady improvement in results, which was also reflected in the single-center mid-term data up to 3 years. The preliminary results from national European registries have been remarkably comparable in terms of survival and stroke. The "glimpse into the future" points toward implantation in intermediate-risk patients in contrast to high-risk or inoperable patients. The results of the Medtronic Surgical Replacement and Transcatheter Aortic Valve Implantation and Edwards Placement of Aortic Transcatheter Valves Trial 2 trials will show whether this change in paradigm is justified.