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Aortic valve replacement in Germany in 2019

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Abstract

Aims

Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established options to treat aortic valve stenosis. We present the outcome of the complete cohort of all patients undergoing SAVR or TAVI in Germany during the calendar year 2019.

Methods and results

Data concerning all isolated aortic valve procedures performed in Germany in 2019 were retrieved from the mandatory nationwide quality control program: 22,973 transvascular (TV)-TAVI procedures, 7905 isolated SAVR (iSAVR), and 1413 transapical (TA)-TAVI. Data was complete in 99.9% (n = 32,156). In-hospital mortality after TV-TAVI (2.3%) was significantly lower when compared with iSAVR (2.8%, p = 0.007) or TA-TAVI (6.3%; p < 0.001). Expected mortality was calculated with a new version of the German Aortic valve score (AKL Score) based on the data of either catheter-based (AKL-CATH) or surgical (AKL-CHIR) aortic valve replacements in Germany in 2018. TV-TAVI and iSAVR both showed lower observed mortality in 2019 than expected based on their respective performance in 2018, yielding an observed/expected (O/E) mortality ratio < 1. This was particularly apparent for patients at low risk. After exclusion of emergency procedures, in-hospital mortality after TV-TAVI (2.1%) and after iSAVR (2.1%) was identical, even though patients undergoing TV-TAVI showed a considerably higher perioperative risk profile.

Conclusion

After excluding emergency procedures, in-hospital mortality of TV-TAVI and iSAVR in 2019 in Germany was identical. In 2019, TV-TAVI and iSAVR both show lower matched mortality ratios compared with 2018, which suggests technical improvements of both therapies.

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Acknowledgements

We thank Elizabeth Martinson, Ph.D., of the KHFI Editorial Office for her editorial assistance.

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Correspondence to Helge Möllmann.

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Conflict of interest

HM received speaker honoraria/proctor fees from Abbott, Biotronik, Boston Scientific, Edwards Lifesciences, and SMT; OH and JB received proctor fees from Boston Scientific; LG receives speaker honoraria from Edwards and Abbott; CWH receives honoraria from Medtronic as International Advisory Board Member. HN.

Ethical approval

The study compliances with ethical standards. The data derives from the anonymous mandatory nationwide quality control program available online.

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Gaede, L., Blumenstein, J., Husser, O. et al. Aortic valve replacement in Germany in 2019. Clin Res Cardiol 110, 460–465 (2021). https://doi.org/10.1007/s00392-020-01788-6

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  • DOI: https://doi.org/10.1007/s00392-020-01788-6

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