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Clinical Research in Cardiology

, Volume 106, Issue 8, pp 610–617 | Cite as

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

  • Christian Frerker
  • Kurt Bestehorn
  • Michael Schlüter
  • Maike Bestehorn
  • Christian W. Hamm
  • Helge Möllmann
  • Hugo A. Katus
  • Karl-Heinz Kuck
Original Paper

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.

Keywords

Aortic valve replacement Surgery TAVR Registry In-hospital mortality 

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

Notes

Compliance with ethical standards

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.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of CardiologyAsklepios Klinik St. GeorgHamburgGermany
  2. 2.Technische Universität DresdenDresdenGermany
  3. 3.Asklepios ProresearchHamburgGermany
  4. 4.ProMedCon GmbHEbenhausenGermany
  5. 5.Department of Medical Clinic IUniversity of GiessenGiessenGermany
  6. 6.Department of CardiologyKerckhoff Heart CenterBad NauheimGermany
  7. 7.Department of CardiologySt. Johannes Hospital, DortmundDortmundGermany
  8. 8.Center for Internal MedicineHeidelberg University HospitalHeidelbergGermany

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