Introduction

Based on European guidelines, transcatheter aortic valve implementation (TAVI) could be the therapy of choice in patients with severe aortic stenosis aged ≥ 75 years. In the Netherlands, there has been a debate between healthcare providers and the National Health Care Institute regarding reimbursement for TAVI, which resulted in an indication document that defines TAVI patients who are eligible for reimbursement. This document has been effective since 1 January 2021.

Methods

We extracted data from the Netherlands Heart Registry for patients who underwent biological surgical aortic valve replacement (SAVR) or TAVI in the Netherlands from 2018 through 2021. We compared baseline characteristics and variables from the indication document for the subsequent years and age groups. We also analysed the annual SAVR/TAVI ratio.

Results

The total number of patients treated with SAVR or TAVI was constant in 2018–2021. Baseline characteristics of patients treated with TAVI did not differ throughout the years. The SAVR/TAVI ratio shifted towards a higher percentage of TAVI from 2018 to 2019. From 2019 to 2020, the TAVI percentage was constant. Since the implementation of the indication document (in 2021), a change in the SAVR/TAVI ratio was not found either.

Conclusion

Since the implementation of the national indication document for AVR in 2021, no major effect was seen for the SAVR versus TAVI landscape in the Netherlands.

中文翻译：

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荷兰的国家适应症文件和主动脉瓣置换情况

介绍

根据欧洲指南，经导管主动脉瓣置换术 (TAVI) 可能是 75 岁以上重度主动脉瓣狭窄患者的首选治疗方法。在荷兰，医疗保健提供者和国家卫生保健研究所之间就 TAVI 报销问题进行了争论，最终形成了一份指示文件，定义了有资格获得报销的 TAVI 患者。本文件自2021年1月1日起生效。

方法

我们从荷兰心脏登记处提取了 2018 年至 2021 年在荷兰接受生物外科主动脉瓣置换术 (SAVR) 或 TAVI 的患者的数据。我们比较了随后年份和年龄组的基线特征和适应症文件中的变量。我们还分析了年度 SAVR/TAVI 比率。

结果

2018-2021 年接受 SAVR 或 TAVI 治疗的患者总数保持不变。多年来，接受 TAVI 治疗的患者的基线特征没有差异。从 2018 年到 2019 年，SAVR/TAVI 比率转向更高的 TAVI 百分比。从 2019 年到 2020 年，TAVI 百分比保持不变。自指示文件实施（2021年）以来，SAVR/TAVI比率也未发现变化。

结论

自 2021 年 AVR 国家适应症文件实施以来，荷兰的 SAVR 与 TAVI 格局并未出现重大影响。