Friedhelm Beyersdorf1,2, Timm Bauer3, Nick Freemantle4, Thomas Walther5, Christian Frerker6, Eva Herrmann7,8, Sabine Bleiziffer9, Helge Möllmann10, Sandra Landwehr11, Stephan Ensminger12, Raffi Bekeredjian13, Jochen Cremer14, Karl Heinz Kuck15, Buntaro Fujita12, Jan Gummert9, Lisa Müller11, Andreas Beckmann16, Christian W Hamm17. 1. Department of Cardiovascular Surgery, University Heart Center Freiburg-Bad Krozingen, Freiburg, Germany. 2. Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg, Germany. 3. Department of Cardiology, Sana Klinikum Offenbach, Offenbach, Germany. 4. Comprehensive Clinical Trial Unit, University College London, London, UK. 5. Department of Thoracic, Cardiac and Thoracic Vascular Surgery, University of Frankfurt, Frankfurt, Germany. 6. Department of Cardiology, University Hospital Cologne, University of Cologne, Faculty of Medicine, Cologne, Germany. 7. German Center for Cardiovascular Research (DZHK), Partner Site Rhein/Main, Germany. 8. Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany. 9. Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Bad Oeynhausen, Germany. 10. Department of Internal Medicine I, St.-Johannes-Hospital, Dortmund, Germany. 11. BQS Institute for Quality and Patient Safety, Düsseldorf, Germany. 12. Department of Cardiac Surgery, University Hospital Lübeck, Lübeck, Germany. 13. Department of Cardiology, Robert-Bosch-Hospital, Stuttgart, Germany. 14. Department of Cardiac and Vascular Surgery, University Hospital Kiel, Kiel, Germany. 15. Department of Cardiology, Angiology, Intensive Care, University Hospital Lübeck, Lübeck, Germany. 16. Germany Society for Thoracic and Cardiovascular Surgery, Berlin, Germany. 17. Department of Cardiology, Campus Kerckhoff University of Giessen, Bad Nauheim, Germany.
Abstract
OBJECTIVES: To determine the 5-year outcome in patients treated by isolated transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (sAVR)-a prospective observational cohort study. METHODS: A total of 18 010 patients were included (n = 8942 TAVI and n = 9068 sAVR) in the German Aortic Valve Registry (GARY) who were treated in 2011 and 2012 at 92 sites in central Germany. Eligible patients with TAVI and sAVR were matched using propensity scores in a nearest-neighbour approach. Patients with repeat procedures or unequivocal indication for one treatment option (e.g. frailty) were excluded (n = 4785 for TAVI and n = 2 for sAVR). This led to 13 223 patients (4157 TAVI and 9066 sAVR) as an unmatched subcohort. The main outcome measure was the 5-year all-cause mortality. RESULTS: TAVI patients were significantly older (80.9 ± 6.1 vs 68.5 ± 11.1 years, P < 0.001), had a higher Society of Thoracic Surgeons (STS) score (6.3 ± 4.9 vs 2.6 ± 3.0, P < 0.001) and a higher 5-year all-cause mortality (49.8% vs 16.5%, P < 0.0001). There was no major difference in in-hospital stroke, in-hospital myocardial infarction, or temporary and chronic dialysis. In the propensity score-matched group (n = 3640), there were 763 deaths (41.9%) among 1820 TAVI patients compared with 552 (30.3%) among 1820 treated with sAVR during the 5-year follow-up (hazard ratio 1.51, 95% confidence interval 1.35-1.68; P < 0.0001). New pacemaker implantation was performed in 448 patients (24.6%) after TAVI and in 201 (11.0%) after sAVR (P < 0.0001). CONCLUSIONS: The 5-year follow-up data show that TAVI patients were significantly older and had a higher STS score than sAVR patients. After propensity score matching, TAVI with early-generation prosthesis was associated with significantly higher 5-year all-cause mortality than sAVR.
OBJECTIVES: To determine the 5-year outcome in patients treated by isolated transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (sAVR)-a prospective observational cohort study. METHODS: A total of 18 010 patients were included (n = 8942 TAVI and n = 9068 sAVR) in the German Aortic Valve Registry (GARY) who were treated in 2011 and 2012 at 92 sites in central Germany. Eligible patients with TAVI and sAVR were matched using propensity scores in a nearest-neighbour approach. Patients with repeat procedures or unequivocal indication for one treatment option (e.g. frailty) were excluded (n = 4785 for TAVI and n = 2 for sAVR). This led to 13 223 patients (4157 TAVI and 9066 sAVR) as an unmatched subcohort. The main outcome measure was the 5-year all-cause mortality. RESULTS: TAVI patients were significantly older (80.9 ± 6.1 vs 68.5 ± 11.1 years, P < 0.001), had a higher Society of Thoracic Surgeons (STS) score (6.3 ± 4.9 vs 2.6 ± 3.0, P < 0.001) and a higher 5-year all-cause mortality (49.8% vs 16.5%, P < 0.0001). There was no major difference in in-hospital stroke, in-hospital myocardial infarction, or temporary and chronic dialysis. In the propensity score-matched group (n = 3640), there were 763 deaths (41.9%) among 1820 TAVI patients compared with 552 (30.3%) among 1820 treated with sAVR during the 5-year follow-up (hazard ratio 1.51, 95% confidence interval 1.35-1.68; P < 0.0001). New pacemaker implantation was performed in 448 patients (24.6%) after TAVI and in 201 (11.0%) after sAVR (P < 0.0001). CONCLUSIONS: The 5-year follow-up data show that TAVI patients were significantly older and had a higher STS score than sAVR patients. After propensity score matching, TAVI with early-generation prosthesis was associated with significantly higher 5-year all-cause mortality than sAVR.
Authors: Victor Dayan; Ovidio A Garcia-Villarreal; Alejandro Escobar; Javier Ferrari; Eduard Quintana; Mateo Marin-Cuartas; Rui M S Almeida Journal: Braz J Cardiovasc Surg Date: 2021-08-06