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Aortic valve replacement in Germany in 2019.

Luise Gaede1, Johannes Blumenstein2, Oliver Husser2

  • 1Medizinische Klinik 2, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.

Clinical Research in Cardiology : Official Journal of the German Cardiac Society
|January 3, 2021
PubMed
Summary

Transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) showed identical in-hospital mortality rates in 2019 for non-emergency procedures. Both TAVI and SAVR demonstrated improved outcomes compared to 2018, indicating technical advancements.

Keywords:
MortalityReal worldRegistrySAVRTAVITAVR

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology

Background:

  • Aortic valve stenosis is a significant cardiovascular condition requiring intervention.
  • Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established treatment options.
  • Comparative outcomes data are crucial for guiding clinical decisions.

Purpose of the Study:

  • To compare the outcomes of SAVR and TAVI in a complete national cohort.
  • To analyze in-hospital mortality rates for isolated aortic valve procedures in Germany in 2019.

Main Methods:

  • Analysis of mandatory nationwide quality control data for all isolated aortic valve procedures in Germany in 2019.
  • Inclusion of 22,973 transvascular (TV)-TAVI, 7905 isolated SAVR (iSAVR), and 1413 transapical (TA)-TAVI procedures.
  • Calculation of expected mortality using a new version of the German Aortic valve score (AKL Score) and comparison with observed mortality.

Main Results:

  • In-hospital mortality was significantly lower for TV-TAVI (2.3%) compared to iSAVR (2.8%) and TA-TAVI (6.3%).
  • After excluding emergency procedures, in-hospital mortality was identical for TV-TAVI (2.1%) and iSAVR (2.1%), despite a higher risk profile in TV-TAVI patients.
  • Both TV-TAVI and iSAVR showed lower observed than expected mortality (O/E ratio < 1), particularly in low-risk patients.

Conclusions:

  • Non-emergency TV-TAVI and iSAVR demonstrated identical in-hospital mortality rates in 2019.
  • Both TAVI and SAVR procedures showed improved outcomes compared to 2018, suggesting technical advancements in both therapies.