Luise Gaede1, Johannes Blumenstein2, Oliver Husser2, Christoph Liebetrau3, Oliver Dörr4, Christina Grothusen2, Clemens Eckel2, Hani Al-Terki2, Won-Keun Kim5, Holger Nef4, Christian Tesche2, Christian W Hamm4,5, Albrecht Elsässer6, Stephan Achenbach1, Helge Möllmann7. 1. Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland. 2. Department of Internal Medicine, Medizinische Klinik 1, St. Johannes-Hospital, Johannesstrasse 9-17, 44137, Dortmund, Germany. 3. CCB Frankfurt, Frankfurt, Germany. 4. Medical Clinic I, Department of Cardiology and Angiology, University of Giessen, Giessen, Germany. 5. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany. 6. Carl Von Ossietzky Universität Oldenburg, Oldenburg, Germany. 7. Department of Internal Medicine, Medizinische Klinik 1, St. Johannes-Hospital, Johannesstrasse 9-17, 44137, Dortmund, Germany. moellmann@me.com.
Abstract
AIMS: Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established options to treat aortic valve stenosis. We present the outcome of the complete cohort of all patients undergoing SAVR or TAVI in Germany during the calendar year 2019. METHODS AND RESULTS: Data concerning all isolated aortic valve procedures performed in Germany in 2019 were retrieved from the mandatory nationwide quality control program: 22,973 transvascular (TV)-TAVI procedures, 7905 isolated SAVR (iSAVR), and 1413 transapical (TA)-TAVI. Data was complete in 99.9% (n = 32,156). In-hospital mortality after TV-TAVI (2.3%) was significantly lower when compared with iSAVR (2.8%, p = 0.007) or TA-TAVI (6.3%; p < 0.001). Expected mortality was calculated with a new version of the German Aortic valve score (AKL Score) based on the data of either catheter-based (AKL-CATH) or surgical (AKL-CHIR) aortic valve replacements in Germany in 2018. TV-TAVI and iSAVR both showed lower observed mortality in 2019 than expected based on their respective performance in 2018, yielding an observed/expected (O/E) mortality ratio < 1. This was particularly apparent for patients at low risk. After exclusion of emergency procedures, in-hospital mortality after TV-TAVI (2.1%) and after iSAVR (2.1%) was identical, even though patients undergoing TV-TAVI showed a considerably higher perioperative risk profile. CONCLUSION: After excluding emergency procedures, in-hospital mortality of TV-TAVI and iSAVR in 2019 in Germany was identical. In 2019, TV-TAVI and iSAVR both show lower matched mortality ratios compared with 2018, which suggests technical improvements of both therapies.
AIMS: Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established options to treat aortic valve stenosis. We present the outcome of the complete cohort of all patients undergoing SAVR or TAVI in Germany during the calendar year 2019. METHODS AND RESULTS: Data concerning all isolated aortic valve procedures performed in Germany in 2019 were retrieved from the mandatory nationwide quality control program: 22,973 transvascular (TV)-TAVI procedures, 7905 isolated SAVR (iSAVR), and 1413 transapical (TA)-TAVI. Data was complete in 99.9% (n = 32,156). In-hospital mortality after TV-TAVI (2.3%) was significantly lower when compared with iSAVR (2.8%, p = 0.007) or TA-TAVI (6.3%; p < 0.001). Expected mortality was calculated with a new version of the German Aortic valve score (AKL Score) based on the data of either catheter-based (AKL-CATH) or surgical (AKL-CHIR) aortic valve replacements in Germany in 2018. TV-TAVI and iSAVR both showed lower observed mortality in 2019 than expected based on their respective performance in 2018, yielding an observed/expected (O/E) mortality ratio < 1. This was particularly apparent for patients at low risk. After exclusion of emergency procedures, in-hospital mortality after TV-TAVI (2.1%) and after iSAVR (2.1%) was identical, even though patients undergoing TV-TAVI showed a considerably higher perioperative risk profile. CONCLUSION: After excluding emergency procedures, in-hospital mortality of TV-TAVI and iSAVR in 2019 in Germany was identical. In 2019, TV-TAVI and iSAVR both show lower matched mortality ratios compared with 2018, which suggests technical improvements of both therapies.
Entities:
Keywords:
Mortality; Real world; Registry; SAVR; TAVI; TAVR
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