Aims Transcatheter aortic valve replacement (TAVR) as an alternative to surgical aortic valve replacement (SAVR) has profoundly changed the management of patients with aortic valve stenosis (AS). Large unbiased nationwide data regarding TAVR implementation, impact on SAVR and their respective outcomes are scarce. Methods and results Based on a French administrative hospital-discharge database, we collected data on all consecutive aortic valve replacements (AVRs) performed in France for AS between 2007 and 2019 [106 253 isolated SAVR (49%), 46 514 combined SAVR (21%), and 65 651 TAVR (30%)]. The number of AVR linearly increased between 2007 and 2019 (from 10 892 to 23 109, P for trend < 0.0001) due to a marked increase in TAVR (from 253 to 13 030, P for trend < 0.0001), while SAVR increased up to 2013 and then declined (10 892 in 2007, 12 699 in 2013, and 10 079 in 2019). The Charlson index decreased linearly for TAVR, but in two steps for SAVR (2011 and 2017). In-hospital mortality rates of both SAVR and TAVR declined (both P for trend < 0.0001) and were similar or lower for TAVR than for isolated SAVR in patients 75 years or above in the last 3 years (2017–19). Complication rates of TAVR also declined but permanent pacemaker rates remained high and length of stay substantial (16.7% and median 6 days, respectively, in 2017–19). Conclusion The number of AVR has doubled in a decade and TAVR has become the dominant form of AVR in 2018. The improvement in patient profiles seems to have anticipated the demonstrated benefit of TAVR in intermediate and low-risk patients. In patients 75 years or older, TAVR should be considered as the first option. We also highlight two important areas for improvement, the high permanent pacemaker rates, and the long length of stay even in the contemporary era. Our results may have major implications for clinical practice and policymakers.

中文翻译：

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主动脉瓣狭窄主动脉瓣置换术的趋势：一项法国全国性研究

目的 经导管主动脉瓣置换术 (TAVR) 作为外科主动脉瓣置换术 (SAVR) 的替代方法，已经深刻地改变了主动脉瓣狭窄 (AS) 患者的管理。关于 TAVR 实施、对 SAVR 的影响及其各自结果的大量无偏见的全国数据很少。方法和结果 基于法国管理出院数据库，我们收集了 2007 年至 2019 年间在法国为 AS 进行的所有连续主动脉瓣置换术 (AVR) 的数据 [106 253 例单独 SAVR (49%)，46 514 例联合 SAVR (21 %), 和 65 651 TAVR (30%)]。由于 TAVR 显着增加（从 253 增加到 13 030，趋势 P < 0.0001），2007 年至 2019 年 AVR 数量线性增加（从 10 892 增加到 23 109，趋势 P < 0.0001），同时 SAVR 增加到 2013 年，然后下降（2007 年为 10 892，2013 年 12 699 人，2019 年 10 079 人）。TAVR 的 Charlson 指数线性下降，但 SAVR 分两步下降（2011 年和 2017 年）。在过去 3 年 (2017-19) 中，75 岁或以上患者的 SAVR 和 TAVR 院内死亡率均下降（趋势 P < 0.0001）并且 TAVR 与单纯 SAVR 相似或更低。TAVR 的并发症发生率也有所下降，但永久起搏器的发生率仍然很高，住院时间也很长（2017-19 年分别为 16.7% 和中位 6 天）。结论 AVR 的数量在十年内翻了一番，TAVR 已成为 2018 年 AVR 的主要形式。患者概况的改善似乎预示着 TAVR 在中低危患者中的获益。对于 75 岁或以上的患者，TAVR 应被视为首选。我们还强调了两个需要改进的重要领域，即永久性起搏器的高使用率，以及即使在当代也需要较长的住院时间。我们的结果可能对临床实践和决策者有重大影响。