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In-hospital outcome of transcatheter vs. surgical aortic valve replacement in patients with aortic valve stenosis: complete dataset of patients treated in 2013 in Germany

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Abstract

Background

Transvascular (TV-AVI) or transapical (TA-AVI) aortic valve implantation (TAVI) is a treatment option for patients with aortic stenosis being at high or prohibitive risk for surgical aortic valve implantation (SAVR). Randomized data demonstrated that these subgroups can safely been treated with TAVI. However, a comparison of SAVR and TAVI in intermediate and low-risk patients is missing. Therefore, the aim of the analysis was to compare TAVI and SAVR in all patients who were treated for aortic valve stenosis in Germany throughout 1 year.

Methods

The mandatory quality assurance collects data on the in-hospital outcome from all patients (n = 20,340) undergoing either SAVR or TAVI in Germany. In order to compare the different treatment approaches patients were categorized into four risk groups using the logistic EuroScore I (ES). In-hospital mortality and peri- and postprocedural complications were analyzed.

Results

The in-hospital mortality did not differ between TV-AVI and SAVR in the low risk group (ES <10 %: TV-AVI 2.4 %, SAVR 2.0 %, p = 0.302) and was significantly higher for SAVR in all other risk groups (ES 10–20 %: TV-AVI 3.5 %, SAVR 5.3 %; p = 0.025; ES 20–30 %: TV-AVI 5.5 %, SAVR 12.2 %, p < 0.001; ES >30 %: TV-AVI 6.5 %, SAVR 12.9 %, p = 0.008). TA-AVI had a significantly higher mortality in all risk groups compared to TV-AVI. In comparison to SAVR, TA-AVI had a higher mortality in patients with ES <10, comparable mortality in ES 10–20 %, and lower mortality in patients with an ES >20 %. The overall stroke rate was 2.3 %. It occurred more frequently in patients with an ES <10 % treated with a transapical approach (SAVR 1.8 %, TV-AVI 1.9 %, TA-AVI 3.1 %, p < 0.01). There were no statistically significant differences in all other comparisons.

Conclusions

This study demonstrates that TAVI provides excellent outcomes in all risk categories. Compared with SAVR, TV-TAVI yields similar in-hospital mortality among low-risk patients and lower in-hospital mortality among intermediate and high-risk patient populations.

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Author notes

    Authors and Affiliations

    1. Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany

      Helge Möllmann & Christian Hamm

    2. Institut für klinische Pharmakologie, TU Dresden, Dresden, Germany

      Kurt Bestehorn & Maike Bestehorn

    3. Deutsche Gesellschaft für Kardiologie, Herz- und Kreislaufforschung, Düsseldorf, Germany

      Konstantinos Papoutsis & Eckart Fleck

    4. Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany

      Georg Ertl

    5. St. Georg Krankenhaus Hamburg, Hamburg, Germany

      Karl-Heinz Kuck

    Authors
    1. Helge Möllmann
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    Correspondence to Helge Möllmann.

    Additional information

    H. Möllmann and K. Bestehorn contributed equally to this manuscript.

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    Möllmann, H., Bestehorn, K., Bestehorn, M. et al. In-hospital outcome of transcatheter vs. surgical aortic valve replacement in patients with aortic valve stenosis: complete dataset of patients treated in 2013 in Germany. Clin Res Cardiol 105, 553–559 (2016). https://doi.org/10.1007/s00392-016-0962-4

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    • DOI: https://doi.org/10.1007/s00392-016-0962-4

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