Department of Cardio-Thoracic Surgery, Erasmus University Medical Center, s'-Gravendijkwal, CE Rotterdam, The Netherlands.
Department of Interventional Cardiology, Erasmus University Medical Center, s'-Gravendijkwal, CE Rotterdam, The Netherlands.
Eur Heart J. 2018 Jul 21;39(28):2635-2642. doi: 10.1093/eurheartj/ehy107.
The number of transcatheter aortic valve implantation (TAVI) procedures is rapidly increasing. This has a major impact on health care resource planning. However, the annual numbers of TAVI candidates per country are unknown. The aim of this study was to estimate current and future number of annual TAVI candidates in 27 European countries, the USA and Canada.
Systematic literature searches and meta-analyses were performed on aortic stenosis (AS) epidemiology and decision-making in severe symptomatic AS. The incidence rate of severe AS was determined. Findings were combined with population statistics and integrated into a model employing Monte Carlo simulations to predict the annual number of TAVI candidates. Various future scenarios and sensitivity analyses were explored. Data from 37 studies (n = 26 402) informed the model. The calculated incidence rate of severe AS was 4.4‰/year [95% confidence interval (95% CI) 3.0-6.1‰] in patients ≥65 years. AS-related symptoms were present in 68.3% (95% CI 60.8-75.9%) of patients with severe AS. Despite having severe symptomatic AS, 41.6% (95% CI 36.9-46.3%) did not undergo surgical aortic valve replacement. Of the non-operated patients, 61.7% (95% CI 42.0-81.7%) received TAVI. The model predicted 114 757 (95% CI 69 380-172 799) European and 58 556 (95% CI 35 631-87 738) Northern-American TAVI candidates annually.
Currently, approximately 180 000 patients can be considered potential TAVI candidates in the European Union and in Northern-America annually. This number might increase up to 270 000 if indications for TAVI expand to low-risk patients. These findings have major implications for health care resource planning in the 29 individual countries.
经导管主动脉瓣植入术（TAVI）的数量正在迅速增加。这对医疗保健资源规划有重大影响。然而，每个国家每年 TAVI 候选人数尚不清楚。本研究的目的是估计 27 个欧洲国家、美国和加拿大目前和未来每年 TAVI 候选人数。
对主动脉瓣狭窄（AS）的流行病学和严重有症状 AS 的决策进行了系统的文献检索和荟萃分析。确定了严重 AS 的发病率。将研究结果与人口统计学相结合，并整合到一个使用蒙特卡罗模拟的模型中，以预测 TAVI 候选人数。探讨了各种未来情景和敏感性分析。来自 37 项研究（n=26402）的数据为模型提供了信息。计算出≥65 岁患者严重 AS 的发病率为 4.4‰/年[95%置信区间（95%CI）3.0-6.1‰]。68.3%（95%CI 60.8-75.9%）的严重 AS 患者存在 AS 相关症状。尽管患有严重有症状的 AS，但 41.6%（95%CI 36.9-46.3%）未接受外科主动脉瓣置换术。在未接受手术的患者中，61.7%（95%CI 42.0-81.7%）接受了 TAVI。该模型预测每年有 114757 名（95%CI 69380-172799）欧洲人和 58556 名（95%CI 35631-87738）北美 TAVI 候选者。
目前，每年约有 180000 名患者可被视为欧盟和北美地区的潜在 TAVI 候选者。如果 TAVI 的适应证扩大到低危患者，这一数字可能会增加到 270000 人。这些发现对 29 个国家的医疗保健资源规划有重大影响。
