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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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).
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.
KeywordsAortic valve replacement Surgery TAVR Registry In-hospital mortality
Aortic valve replacement
European system for cardiac operative risk evaluation
Placement of aortic transcatheter valve
Surgical aortic valve replacement
Transcatheter aortic valve replacement
Transcatheter heart valve
Compliance with ethical standards
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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