Predicting the Surge in Valve-in-Valve Volume

JACC. Asia Pub Date : 2025-10-01 DOI:10.1016/j.jacasi.2025.07.014

Yohei Ohno MD , Philippe Généreux MD , Roy D. Dar PhD , Ulrich Gerckens MD , Danny Dvir MD , Didier Tchétché MD , Norihiko Kamioka MD , Shinichi Shirai MD , Norio Tada MD , Masanori Yamamoto MD , Kentaro Hayashida MD , Yusuke Watanabe MD

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引用次数: 0

Abstract

Background

Understanding trends in transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) utilization is essential for predicting valve-in-valve (ViV) TAVR usage, a viable option for failed bioprosthetic valves that presents a promising avenue for lifetime management of aortic stenosis.

Objectives

This study aimed to predict and compare the future annual ViV volume in the United States and Japan based on past and current TAVR/SAVR utilization under some underlying assumptions.

Methods

We developed a MATLAB-based Monte Carlo model engine to simulate the lifespan of bioprosthetic TAVR and SAVR valves. The valves are simulated for each individual TAVR/SAVR procedure from 1998 to 2035, accounting for over 4.4 million AVRs in the United States and 800,000 AVRs in Japan. The model allocates ages of the index procedure, valve durability, patient survival postprocedure, and accounts for redo open-heart procedures (in the U.S. model).

Results

The model outputs for total annual ViV volume for the United States and Japan show strong alignment with the 2023 TVT (Transcatheter Valve Therapy) and 2024 J-TVT (Japanese Transcatheter Valve Therapy) registry data, respectively. Both the U.S. and Japan ViV trends are made up of 2 parts—TAVR-in-SAVR dominates initially, after which TAVR-in-TAVR rises and dominates, with TAVR-in-SAVR flattening out after 2028. Total ViV is projected to reach approximately 42,000 (95% CI: 41,888-42,112) U.S. procedures (∼15% of U.S. TAVR) and 4,972 (95% CI: 4,935-5,009) Japanese procedures (∼8% of Japanese TAVR) in 2035.

Conclusions

Future ViV procedures are predicted to surge in the United States and Japan, with TAVR-in-TAVR dominating both markets in 2035.

查看原文本刊更多论文

阀内容积激增预测：日本与美国的比较研究。

背景：了解经导管主动脉瓣置换术（TAVR）和外科主动脉瓣置换术（SAVR）的使用趋势对于预测瓣膜中瓣膜（ViV） TAVR的使用至关重要，这是失败的生物假体瓣膜的可行选择，为主动脉瓣狭窄的终身治疗提供了一条有希望的途径。目的：本研究旨在基于过去和当前TAVR/SAVR利用率，在一些基本假设下预测和比较美国和日本未来的年度ViV量。方法：我们开发了一个基于matlab的蒙特卡罗模型引擎来模拟生物假体TAVR和SAVR瓣膜的寿命。从1998年到2035年，对每个单独的TAVR/SAVR程序进行了阀门模拟，美国有440多万avr，日本有80万avr。该模型分配了索引手术的年龄、瓣膜的耐久性、术后患者的生存率，并考虑了再做一次心内直视手术（在美国模型中）。结果：美国和日本的年度ViV总量模型输出分别与2023年TVT（经导管瓣膜治疗）和2024年J-TVT（日本经导管瓣膜治疗）注册数据有很强的一致性。美国和日本的ViV趋势都由两部分组成，一开始TAVR-in-SAVR占主导地位，之后TAVR-in-TAVR上升并占据主导地位，2028年后TAVR-in-SAVR趋于平缓。预计到2035年，总ViV将达到约42,000例（95% CI: 41,888-42,112）美国手术（约占美国TAVR的15%）和4,972例（95% CI: 4,935-5,009）日本手术（约占日本TAVR的8%）。结论：预计未来试管婴儿手术将在美国和日本激增，到2035年，TAVR-in-TAVR将主导这两个市场。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

JACC. Asia Cardiology and Cardiovascular Medicine

CiteScore

4.00

自引率

0.00%

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