Insights from eight years of adoption experience of transcatheter mitral valve repair in Germany: observed utilisation patterns and impact on overall mitral valve procedure volumes.

Aims: The German healthcare system was among the first to introduce transcatheter mitral valve repair (TMVR) into routine care. The objective of this study was to analyse adoption and utilisation patterns and to estimate the impact of TMVR availability on mitral valve (MV) procedure volumes in the first eight years after commercialisation.

Methods And Results: Procedure volumes were collected from German Federal Statistics Office databases for TMVR and mitral valve surgery (MVS) from 2008-2015. Procedure volumes were stratified by age group (<65, 65-74, 75-84, ≥85 years). Overall procedure volumes grew from 14,525 to 24,898 (+71%). MVS procedures grew from 14,477 to 20,402 (+41%) (p=0.008). The proportion of TMVR procedures grew from 0.3% (48 procedures) to 18.1% (4,496 procedures) (p=0.008). In 2015, TMVR use reached 5%, 15%, 31%, and 68% of overall MV procedures in the studied age groups (<65, 65-74, 75-84, ≥85 years). MVS volumes grew in all age groups, with the highest increase in the age group <65 (+2,945).

Conclusions: The availability of TMVR has contributed to a pronounced increase in MV procedure volumes in Germany. Simultaneously, MVS procedure volumes continued to grow substantially. The highest increase of TMVR was observed in elderly populations, suggesting referral of patients with MV disease previously left untreated.