Evolution of mitral valve procedural volumes in the advent of endovascular treatment options: Experience at an early-adopting center in Germany.
OBJECTIVE
Our objectives were to assess the evolution of surgical and endovascular mitral valve procedural volumes and to study utilization and reimbursement effects of transcatheter mitral valve repair (TMVR) at our center and to put these in perspective with the corresponding data at the national level.


BACKGROUND
TMVR using the MitraClip system has been available in Germany since 2008 as a complementary treatment option for high-risk or inoperable patients.


METHODS
Relevant procedure codes were identified for 2006-2012 and yearly utilization volumes obtained from our center's databases and from the national statistics office. Volumes were analyzed in total, and stratified by treatment approach. Procedure reimbursement at our center was determined for years 2007-2012.


RESULTS
At our center, 378 MitraClip procedures were performed from 2008 to 2012. During this period, surgical volumes grew at an average of 10.6% annually (2008: 262; 2012: 392; 49.6% total growth rate). Total surgical and TMVR reimbursement increased from EUR 3.8 million (2007) to EUR 7.9 million (2012). By comparison, mitral valve procedural volumes grew by 56.1% from 2006 to 2012 at the national level, with TMVR constituting 9.1% of 20,328 procedures in 2012. Since the introduction of MitraClip, nationwide surgical procedural volumes grew at an average of 6.3% annually (2008: 14,477; 2012: 18,478; 27.6% total growth rate).


CONCLUSIONS
Growth in procedural volumes during 2006-2012 reflects an increasing supply and subsequent demand for mitral valve procedures. The introduction of TMVR has contributed to overall growth, and has not reduced continued growth in surgical volumes. Our center-specific analysis suggests a "halo effect" of an integrated approach to mitral valve disease contributing to additional growth in surgical and overall reimbursement volumes.
University Heart Center Hamburg, Hamburg, Germany.
Lenard
L
Conradi
University Heart Center Hamburg, Hamburg, Germany.
Edith
E
Lubos
University Heart Center Hamburg, Hamburg, Germany.
Hendrik
H
Treede
Wing Tech Inc., Menlo Park, California.
Jan Benjamin
JB
Pietzsch
Wingtec GmbH, Karlsruhe, Germany.
Simon
S
Weber
Wingtec GmbH, Karlsruhe, Germany.
Malte
M
Pietzsch
University Heart Center Hamburg, Hamburg, Germany.
Karin
K
Overlack
University Heart Center Hamburg, Hamburg, Germany.
Patrick
P
Diemert
University Heart Center Hamburg, Hamburg, Germany.
Stefan
S
Blankenberg
University Heart Center Hamburg, Hamburg, Germany.
Hermann
H
Reichenspurner
D000368:Aged; D017130:Angioplasty / Q000379:methods / Q000706:statistics & numerical data*; D006328:Cardiac Catheterization; D015331:Cohort Studies; D004452:Echocardiography; D005260:Female; D005858:Germany; D019538:Health Care Surveys; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
mitral valve disease; percutaneous intervention; percutaneous valve therapy