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In-hospital mortality in propensity-score matched low-risk patients undergoing routine isolated surgical or transfemoral transcatheter aortic valve replacement in 2014 in Germany

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Abstract

Aims

Recent randomized trials have documented the superiority of TAVR—particularly via transfemoral access—over SAVR in patients with severe aortic stenosis considered to have a high or intermediate operative risk of death. We sought to assess in-hospital outcomes of patients with severe aortic stenosis and a low risk of operative mortality undergoing routine surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR).

Methods and results

We performed a propensity-score matched comparison of all patients undergoing first-time treatment by SAVR or transfemoral TAVR (TF-TAVR) in 2014 in Germany who had a logistic EuroSCORE (logES) ≤ 10%, considered to reflect low surgical risk. The primary endpoint of our analysis was in-hospital mortality. Of 7624 SAVR and 9969 TF-TAVR procedures, 6844 (89.8%) and 2751 patients (27.6%), respectively, were considered low risk with a logES between 1.505 and 10.0%. Matching yielded 805 TF-TAVR/SAVR patient pairs with identical propensity scores and no difference in pertinent baseline characteristics, except for the logES, which was significantly higher in TF-TAVR patients (6.8 ± 1.7 vs. 4.2 ± 1.3% in SAVR patients, P < 0.001). Observed in-hospital mortalities were 1.7% (95% confidence interval, 1.1–3.0%) in SAVR and 2.0% (1.3–3.3%) in TF-TAVR patients (P = 0.85).

Conclusion

Our finding of no difference in in-hospital mortality in propensity-score matched low-surgical-risk patients treated by SAVR or TF-TAVR in a routine clinical setting indicates that TF-TAVR can be offered safely to individual patients, despite their operative risk being low. This finding needs to be confirmed in a randomized trial.

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Abbreviations

AS:

Aortic stenosis

AVR:

Aortic valve replacement

EuroSCORE:

European system for cardiac operative risk evaluation

logES:

Logistic EuroSCORE

PARTNER:

Placement of aortic transcatheter valve

SAVR:

Surgical aortic valve replacement

TAVR:

Transcatheter aortic valve replacement

TA-TAVR:

Transapical TAVR

TF-TAVR:

Transfemoral TAVR

THV:

Transcatheter heart valve

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Author notes

    Authors and Affiliations

    1. Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany

      Christian Frerker & Karl-Heinz Kuck

    2. Technische Universität Dresden, Dresden, Germany

      Kurt Bestehorn

    3. Asklepios Proresearch, Hamburg, Germany

      Michael Schlüter

    4. ProMedCon GmbH, Ebenhausen, Germany

      Maike Bestehorn

    5. Department of Medical Clinic I, University of Giessen, Giessen, Germany

      Christian W. Hamm

    6. Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany

      Christian W. Hamm

    7. Department of Cardiology, St. Johannes Hospital, Dortmund, Dortmund, Germany

      Helge Möllmann

    8. Center for Internal Medicine, Heidelberg University Hospital, Heidelberg, Germany

      Hugo A. Katus

    Authors
    1. Christian Frerker
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    2. Kurt Bestehorn
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    3. Michael Schlüter
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    4. Maike Bestehorn
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    5. Christian W. Hamm
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    8. Karl-Heinz Kuck
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    Corresponding author

    Correspondence to Karl-Heinz Kuck.

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    Funding

    The study was partly funded by an unrestricted grant from the German Cardiac Society.

    Conflicts of interest

    CWH has served on the Advisory Board for Medtronic. HAK has received personal fees from Roche Diagnostics, Bayer Vital, AstraZeneca, and Daiichi Sankyo. KHK has received personal fees from Medtronic, Biosense Webster, and St. Jude Medical. The other authors declare no conflicts of interest.

    Additional information

    C. Frerker and K. Bestehorn contributed equally to this work.

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    Frerker, C., Bestehorn, K., Schlüter, M. et al. In-hospital mortality in propensity-score matched low-risk patients undergoing routine isolated surgical or transfemoral transcatheter aortic valve replacement in 2014 in Germany. Clin Res Cardiol 106, 610–617 (2017). https://doi.org/10.1007/s00392-017-1097-y

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    • DOI: https://doi.org/10.1007/s00392-017-1097-y

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