1. R4 정수웅 / Prof. 김우식 N Engl J Med 2015;373:2438-47. Effect of Availability of Transcatheter Aortic-Valve Replacement on Clinical Practice Jochen Rein.hl, M.D., Klaus Kaier, Ph.D., Holger Reinecke, M.D., Claudia Schmoor, Ph.D., Lutz Frankenstein, M.D., Werner Vach, Ph.D., Alain Cribier, M.D., Friedhelm Beyersdorf, M.D., Christoph Bode, M.D., and Manfred Zehender, M.D., Ph.D.

2. Surgical aortic-valve replacement (SAVR) A major clinical advance in the 1960s The only treatment for cure of aortic stenosis i.e. no disease-modifying pharmacologic therapy Transcatheter aortic-valve replacement (TAVR) Devices for it was approved in 2007 Effective therapy for patients for whom surgery is not an option An alternative for high-risk patients How does this new approach affect current clinical practice? The aim of our analysis was to evaluate how the treatment of patients for aortic stenosis has evolved in Germany since the introduction of TAVR.

3. Transapical Transfemoral

4. Method Retrieve in-hospital data on all isolated surgical aortic- valve replacement and TAVR procedures performed throughout Germany between 2007 and 2013 A diagnosis- and procedure-related remuneration system was introduced in Germany in 2004. ▫Diagnoses are coded according to the International Statistical Classification of Diseases and Related Health Problems, 10th revision, German modification (ICD-10-GM). ▫Endovascular and surgical procedures must be coded according to the German Procedure Classification (OPS).

5. EuroSCORE (European System for CardiacOperative Risk Evaluation) ▫ranges from 0 to 100%, ▫higher scores indicate greater risk ▫A score of more than 20% indicate high surgical risk ▫Age, sex, admission status, and ICD-10-GM codes for coexisting conditions were obtained from the Federal Bureau of Statistics

7. Result

11. 2.41 in unadjusted (6.5% vs 2.8%, p<0.001) 1.30 in adjusted for the EuroSCORE (p<0.001)

15. Conclusion The use of TAVR increased markedly in Germany between 2007 and 2013. Concomitant reduction in the use of surgical aortic-valve replacement was moderate. Patients undergoing TAVR were older and at higher procedural risk than those undergoing surgical aortic-valve replacement. In-hospital mortality decreased in both groups but to a greater extent among patients undergoing TAVR.