Effect of Availability of Transcatheter Aortic-Valve Replacement on Clinical Practice

In Germany, the use of TAVR increased substantially between 2007 and 2013, whereas the use of surgical aortic-valve replacement decreased modestly. Patients undergoing TAVR were older and at higher operative risk. Mortality decreased over time in both groups. Surgical aortic-valve replacement was a major clinical advance in the 1960s 1 and offered a cure for aortic stenosis, a condition for which no disease-modifying pharmacologic therapy is available. Surgical replacement remained the only treatment option until 2007, when devices for transcatheter aortic-valve replacement (TAVR) were approved. 2 Since then, TAVR has become established not only as an effective therapy for patients for whom surgery is not an option 3 but also as an alternative for high-risk patients. 4 The introduction of TAVR has led to questions about the effect of this relatively new approach on current clinical practice and its effect on surgical . . .