Changes in aortic valve replacement procedures in Denmark from 2008 to 2020

• Published in: Heart (British Cardiac Society) Vol. 109; no. 7; pp. 557 - 563
• Main Authors: Graversen, Peter Laursen, Butt, Jawad Haider, Østergaard, Lauge, Jensen, Andreas Dalsgaard, Warming, Peder Emil, Strange, Jarl Emanuel, Møller, Christian H, Schou, Morten, De Backer, Ole, Køber, Lars, Fosbøl, Emil Loldrup
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01.04.2023; BMJ Publishing Group LTD
• Subjects: Age; Aged; Aortic stenosis; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Codes; Comorbidity; Coronary vessels; Denmark; Diabetes; Endocarditis; epidemiology; Heart surgery; heart valve diseases; heart valve prosthesis implantation; Heart Valve Prosthesis Implantation - methods; Hospitals; Humans; Length of stay; Life expectancy; Patients; Prostheses; Risk Factors; Statistical analysis; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Trends; Valvular heart disease; Denmark; United States > US; transcatheter aortic valve replacement; epidemiology; heart valve diseases; aortic stenosis; heart valve prosthesis implantation
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/heartjnl-2022-321594

IntroductionSince 2007, transcatheter aortic valve implantation (TAVI) has emerged as another treatment strategy for severe symptomatic aortic stenosis (AS) compared with surgical aortic valve replacement (SAVR). The objectives were to compare annual rates of aortic valve replacement (AVR) procedures performed in Denmark in the era of TAVI and to assess proportion of AVRs stratified by age with use of age recommendations presented in current guidelines.MethodsUsing Danish nationwide registries, we identified first-time AVRs between 2008 and 2020. Patients who were not diagnosed with AS prior to AVR were excludedResultsThe rate of AVRs increased by 39% per million inhabitants from 2008 to 2020. TAVI has steadily increased since 2008, accounting for 64.2% of all AVRs and 72.5% of isolated AVRs by 2020. Number of isolated SAVRs decreased from 2014 and onwards. The proportion of TAVI increased significantly across age groups (<75 and ≥75 years of age, ptrend<0.001), and TAVI accounted for 91.5% of isolated AVR procedures in elderly patients (aged ≥75 years). Length of hospital stay were significantly reduced for all AVRs during the study period (ptrend all<0.001).ConclusionsThe number of AVRs increased from 2008 to 2020 due to adaptation of TAVI, which represented 2/3 of AVRs and more than 70% of isolated AVRs. In elderly patients, the increased use of AVR procedures was driven by TAVI, in agreement with the age recommendations in current guidelines; however, TAVI was used more frequently in patients aged <75 years, accompanied by a flattening use of SAVR.