title: Estimating the adoption of transcatheter aortic valve replacement by US interventional cardiologists and clinical trialists.
abstract: BACKGROUND
  Despite extensive attention dedicated to transcatheter aortic valve replacement (TAVR) in both the medical literature and lay press, little is known about the anticipated utilization of TAVR by the US cardiology community.
  
  
  OBJECTIVE
  TAVR use is likely to outstrip its initial clinical indications.
  
  
  METHODS
  Four days after approval of the first TAVR device in November 2011 by the US Food and Drug Administration, we emailed an online questionnaire to 201 authors of major TAVR clinical trials (trialists) and 461 recent members of an interventional cardiology professional society (clinicians). Responses were compared using χ(2) , t tests, and analysis of variance.
  
  
  RESULTS
  Of 205 surveys received (response rate 31%; 114 clinicians, 91 trialists), the majority of respondents were interventionalists (86%) working in academic practices (72%). Although most physicians anticipated referring <25% of their patients with severe aortic stenosis for TAVR, 68% believed that TAVR is equally efficacious as open-heart surgery, and 11% believed that moderate-surgical risk patients should also be considered for TAVR. More clinicians (98%) than trialists (81%) expected to routinely refer patients for TAVR (P < 0.001). Furthermore, the clinicians were anticipating less operator training and lower annual volume requirements for performing TAVR, when compared with the trialists (P ≤ 0.001).
  
  
  CONCLUSIONS
  Our findings suggest optimism for TAVR acceptance in the United States., with more conservative expectations regarding training, procedural volume requirements, and anticipated referral patterns among TAVR trialists than clinical interventionalists.
authors.affiliation: Center for Comprehensive Cardiovascular Care, Saint Louis University School of Medicine, St. Louis Missouri.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Stolker
authors.forename: Akshar Y
authors.initials: AY
authors.lastname: Patel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lim
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Hauptman
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000639:trends*; D002309:Cardiology / Q000639:trends*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D002986:Clinical Trials as Topic / Q000639:trends*; D005260:Female; D019538:Health Care Surveys; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000639:trends*; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012017:Referral and Consultation / Q000639:trends; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
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