Insights from 8 Years of Utilization of Transcatheter Mitral Valve Repair in Germany: Observed Utilization Patterns and Impact on Overall Mitral Valve Procedure Volumes

All articles of this category Objectives: The German healthcare system was among the first to introduce transcatheter mitral valve repair (TMVR) in routine care. Objective of this study was to analyze adoption and utilization patterns and to estimate impact of TMVR availability on mitral valve (MV) procedure volumes in the first 8 years after commercialization. Methods: Procedure volumes at the national level were collected from German Federal Statistics Office databases for TMVR and mitral valve surgery (MVS) from 2008 to 2015. Similar data were obtained from our early-adopting center (EAC) of TMVR. Procedure volumes were stratified by age groups (< 65, 65–74, 75–84, ≥85 years). Results: Overall procedure volumes grew from 14,525 to 24,898 (+71%) at the national level, and from 277 to 515 (+86%) at our EAC. MVS procedures grew from 14,477 to 20,402 (+41%) and 262 to 411 (+57%), respectively. The share of TMVR procedures grew from 0.3% (48 procedures) to 18.1% (4,496 procedures) at the national level, and from 5.4% (15 procedures) to 20.2% (104 procedures) at our EAC. At the national level MVS volumes grew in all age groups, with highest growth in age < 65 (+2,945). At our EAC, MVS procedures grew in all age groups (< 65: +77.7%; 65–74: +39.4%; 75–84: +67.4%) except for age ≥85 years. In 2015, TMVR use reached 5%, 15%, 31%, and 68% of overall MV procedures in the studied age groups at the national level, compared with 4%, 13%, 44%, and 80% at the EAC. At the national level, p for trend values was 0.008, both for TMVR and MVS, and 0.345 for difference between the group growth rates. At our EAC, p for trend values was 0.208 for TMVR and 0.014 for MVS, and 0.068 for the difference between the groups. Conclusion: Availability of TMVR has contributed to pronounced growth in MV procedure volumes in Germany. Simultaneously, MVS procedure volumes continued to grow substantially. The highest growth of TMVR was observed in elderly populations suggesting referral of patients with MV disease previously left untreated.