[Transcatheter aortic-valve implantation for aortic stenosis. An established procedure?].

Western countries are facing a huge increase of hemodynamically relevant cases of aortic stenosis in an aging population. In the past, about 33% of patients with symptomatic aortic stenosis were not referred for aortic valve replacement although the three years survival rate is only 25 percent after conservative treatment. In Germany transcatheter aortic-valve implantations (TAVI) procedures are reimbursed according to a DRG number. Its usage its not only regulated in a position paper of the German Society of Cardiology giving detailed recommendations for its application and indication. In Germany, approximately 4.000 TAVI procedures were performed in 2009 and even more are expected in 2010. According to the frequency of its usage, DRG reimbursement, and position papers, TAVI procedures seem to be established. However, according to health regulations a new treatment modality is only established if its safety and efficiency is proven, if there is a demand, and if the procedure has economic advantages. According to this definition TAVI is not established since its safety and efficiency compared to the surgical treatment was not been proven in randomised trials yet. Its economic burden in this context is unclear, too. However, there is a need for an alternative to surgical aortic valve replacement to increase the acceptance of valve implantation in an aging population.