OBJECTIVES: Multiple medical reimbursement systems exist in Europe, which may create unequal dissemination and coverage of innovative medical devices. Even in the setting of regularly revised systems, uptake of new technology may be delayed leading to unequal reimbursement. METHODS: This study analyzed the 2010 geographical trends of transcatheter aortic valve implantation (TAVI) rates in 14 countries (Medtronic CoreValve System and Edwards Sapien). Implant data were gathered from BIBA Medical Ltd, a UK-based provider of consulting and market analysis services for the medical device industry. In addition demographic and economic data were gathered from Eurostat, a statistical office of the European Union. Regression techniques were used to explore the relationship between implant rate and a number of key variables. RESULTS: In 2010, a total of 14,400 TAVI procedures were documented providing an average country-based implant rate of 36.2 per million/Inhabitants.  A seven-fold difference in implantation rate existed between the highest and lowest implanting countries (Germany, 77 per million/inhabitants vs. Norway 12 per million/inhabitants). Implant rates were correlated with per-capita GDP (r2=0,015) , health expenditure (r2=0.15) and number of implanting centers in the country (r2=0.18). At this time, only two European countries have a dedicated tariff for TAVI that is applicable nationwide and covers both the device and the procedure (Germany – €34,900, France - €28,477). Differences between country-specific tariffs depend on the method of DRG calculation. In Austria, the TAVI tariff was made to equal that of surgical aortic valve replacement. Countries such the United Kingdom and Italy have adopted case-by-case funding. In countries such as Belgium and the Netherlands TAVI is funded by the hospital-based budget. CONCLUSIONS: Significant differences in TAVI rates exist among European countries. These observations may help us to better understand unequal patterns of dissemination and coverage of innovative medical devices such as TAVI.