Trends in aortic valve replacement in Germany in 2015: transcatheter versus isolated surgical aortic valve repair

被引:54
作者
Gaede, Luise [1 ]
Blumenstein, Johannes [1 ]
Kim, Won-Keun [2 ]
Liebetrau, Christoph [2 ]
Doerr, Oliver [3 ]
Nef, Holger [3 ]
Hamm, Christian [2 ,3 ]
Elsaesser, Albrecht [4 ]
Moellmann, Helge [1 ]
机构
[1] St Johannes Hosp, Dept Internal Med, Johannesstr 9-13, D-44137 Dortmund, Germany
[2] Kerckhoff Heart & Thorax Ctr, Dept Cardiol, Bad Nauheim, Germany
[3] Univ Giessen, Dept Cardiol & Angiol, Med Clin 1, Giessen, Germany
[4] Klinikum Oldenburg, Dept Cardiol, Oldenburg, Germany
关键词
TAVI; Aortic valve replacement; Outcome; Mortality; Logistic EuroScore; AKL score; RISK; EUROSCORE; STENOSIS; PERFORMANCE; MORTALITY; REGISTRY; SURGERY; SCORE;
D O I
10.1007/s00392-016-1070-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
We analysed the number of procedures, indications, and in-hospital mortality rates of all patients undergoing isolated surgical aortic valve replacement (sAVR) or transvascular (TV-) and transapical (TA-) transcatheter aortic valve implantation (TAVI) from 2012 to 2015 in Germany. More than 31,000 aortic valve procedures were performed in 2015 in Germany, representing a total increase of 4.5% over 2014. TV-TAVI accounts for 13,108 of these procedures, with an increase of 21%, whereas the numbers of isolated sAVR and TA-TAVI decreased slightly. Age, frailty, high risk, and patients' choice were the main reasons for a catheter-based intervention. In 2015, the in-hospital mortality rate after TV-TAVI decreased to 3.4%, approaching that of sAVR (2.9%), despite a considerably higher baseline risk. A stratified analysis according to the German aortic valve (AKL) score demonstrated a further decrease of the in-hospital mortality for TV-TAVI, showing a lower in-hospital mortality rate than expected in all risk groups. Importantly, this also accounts for the lowest risk group with an AKL score < 3% showing an in-hospital mortality rate of 1.7%, which is now comparable to that of sAVR (1.5%). In all other risk groups, the in-hospital mortality in patients undergoing TV-TAVI was lower than in patients undergoing sAVR. Mortality after TV-TAVI keeps decreasing over the last years and equals that of SAVR in the lowest risk cohort in the meanwhile. All TV-TAVI patients have significantly lower observed than expected mortality, which will further lead to a redefinition of standard of care.
引用
收藏
页码:411 / 419
页数:9
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