Conradi L, Schaefer A, Lubos E, Pietzsch JB, Pietzsch M, Weber S, Blankenberg S, Schaefer U, Reichenspurner H. Eight years after commercialization: what is the impact of increasing use of transcatheter mitral valve techniques on surgical procedural volumes? [online; breakout session 3, presentation 5]. Presentation to the Mitral Conclave of the American Association for Thoracic Surgery, New York City, 27–28 April 2017.

Objectives. Transcatheter mitral valve repair (TMVR) has been commercially available in Germany since 2008. Our objective was to gain insights about adoption and utilization patterns and to estimate the impact of TMVR availability on surgical mitral valve (MVS) procedure volumes from 2008 through 2015.

Methods. Therapy- and age-stratified procedure volumes at the national level were collected from German Federal Statistics Office databases for TMVR and mitral valve surgery (MVS) from 2008 through 2015. Volume data from the same period were obtained from one of the early-adopting, high-volume centers of TMVR. For both the national and single-site analyses, we computed therapy-specific and total procedure volumes and growth in total and stratified by age groups (<65, 65–74, 75–84, ≥85 years).

Results. In the time period 2008 to 2015 overall procedure volumes grew from 14,525 to 24,898 (+71%) at the national level, and from 277 to 515 (+86%) at our center. Surgical mitral valve procedures grew from 14,477 to 20,402 (+41%) and 262 to 411 (+57%), respectively. The share of TMVR procedures as part of total mitral valve procedures grew from 0.3% (48 procedures) in 2008 to 18.1% (4,496 procedures) in 2015 at the national level, compared to an increase from 5.4% (15 procedures) to 20.2% (104 procedures) at our site. In 2015, TMVR use reached 5%, 15%, 31%, and 68% in the studied age groups at the national level, compared to 4%, 13%, 44%, and 80% at our site. Compared to base year 2008, surgical procedure volumes grew in all age groups over the 8-year study period, with highest growth in age <65 (+2,945) and smallest growth in age >85 years (+85 procedures). At our site, surgical procedures grew in all age groups except for age >85 years.

Conclusions. Availability of TMVR has contributed to pronounced growth in overall mitral valve procedure volumes in Germany, especially in elderly populations. At the same time, MVS procedure volumes continued to grow substantially. The highest relative growth of TMVR was observed in elderly populations. An interdisciplinary heart team approach seems essential for adequate allocation of patients to TMVR or MVS.