When it comes to transcatheter aortic valve replacement (TAVR), a rising tide lifts all ships, although not equally. Volumes for TAVR and surgical aortic valve replacement (SAVR) spiked in 2012 in the U.S., with TAVR centers reaping the largest gains, according to a study presented Jan. 27 at the annual meeting of the Society of Thoracic Surgeons (STS).
“At TAVR centers we are seeing a drastic increase in volume in surgical aortic valve replacement but we don’t see that drastic increase at centers that don’t have TAVR technology,” J. Matthew Brennan, MD, MPH, of Duke University Medical Center in Durham, N.C., told Cardiovascular Business.
Brennan and colleagues combined data from the STS Adult Cardiac Surgery Database from 2008 to mid-2013 and the STS/American College of Cardiology Transcatheter Therapy Registry to evaluate overall case volume at hospitals. The year 2012 was pivotal in the U.S.; in November 2011 the FDA approved the use of Edwards Lifesciences’ Sapien TAVR system to treat inoperable patients with severe aortic stenosis and in October 2012 approved the device for high-risk patients.
They looked at trends over time for TAVR and SAVR procedures for patients classified as low risk (149,307 patients), intermediate risk (50,571 patients) and high risk (27,280 patients). Between 2008 and 2012, overall case volumes increased by about 8,600 cases, with the greatest gains seen in the lowest risk and TAVR groups. In a breakdown of centers with TAVR vs. centers without TAVR, they found the largest gains in SAVR occurred in centers that offered TAVR.
“What we see clinically is that fairly frequently patients are referred [to centers with TAVR] either for surgical AVR and thought to not be appropriate for surgical AVR and are sent for evaluation for TAVR or vice versa. We see it both ways,” Brennan said. “Physicians in the community are realizing TAVR centers are more of a universal referral center. That is why the referral base is going up at those centers.”
Pent-up demand for an optional approach contributed to the surge in 2012 but it may fluctuate over time in what Brennan described as an ebb and flow. He noted that a backlog of previously untreated patients existed who now are seeking and receiving treatment, but he added that degenerative aortic stenosis is a disease that affects older patients.
“The question is long term will this be a viable treatment option in terms of patient volumes and [as an] economic model, and I think the answer is yes,” he said. “It tends to be older people who get the disease and those older patients will be looking for less invasive therapies.”
The STS annual meeting kicked off Jan. 25 in Orlando, Fla., and will run through Jan. 29.