Introduction on Adoption of Transcatheter Aortic Valve Implantation in Western Europe
Transcatheter aortic valve implantation (TAVI) has emerged as a safe and efficacious treatment in patients with symptomatic severe aortic stenosis (AS) at high- or excessive-risk for surgical aortic valve replacement.1,2 More recently, TAVI technology has been extended to treating high-risk patients with failing aortic or mitral surgical bioprosthetic valves, bicuspid aortic stenosis, pure aortic regurgitation, and lower-risk aortic stenosis patients.3-8 Thus, TAVI technology is increasingly being applied worldwide since Conformi Europenne mark approval of the Edwards SAPIEN (Edwards Lifesciences Inc, Irvine, California, US) and Medtronic CoreValve (Medtronic Inc, Minneapolis, Minnesota, US) systems in 2007.
Importantly, few studies report the adoption of TAVI across nations. Anecdotal evidence of TAVI practice in Europe, and studies describing the adoption of other novel medical devices, such as drug-eluting stents (DES) and implantable cardioverter defibrillators (ICDs), suggest that the use of expensive new technologies may be inconsistent across nations.9,10 Indeed, such is the inequality in the adoption of DES and ICD technology that societal initiatives have been established in an attempt to level the playing field between nations.11
Herein, we profile the adoption of TAVI in Western Europe, highlight some factors that may account for the disparate adoption of TAVI between nations, and present evidence that suggests that this therapy remains greatly underutilised in Europe.