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Transvascular transcatheter aortic valve implantation in 2017

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Abstract

Background

Transcatheter aortic valve implantation (TAVI) is emerging as the standard of care for patients with severe aortic stenosis. Recent results have been favourable even for patients with low periprocedural risk.

Methods

We analysed the number of procedures, complications, and in-hospital mortality rates of all patients undergoing isolated aortic valve replacement in 2017 in Germany, focussing especially on transvascular (TV) TAVI. Patients were stratified according the German Aortic Valve Score (AKL) into the risk classes low, intermediate, high and very high (≥ 10%).

Results

A total of 17,956 TV-TAVI and 9011 isolated surgical aortic valve replacements (iSAVR) were performed in Germany in 2017. Although the total rate of intraprocedural complications after TV-TAVI was the same as in 2016 (both 7.4%), fewer patients experienced an arterial vascular complication in 2017 (2017: 6.0%; 2016: 7.1%; p < 0.001). Likewise, the rate of new pacemaker implantation decreased (2017: 9.6%; 2016:11.4%; p < 0.001). In-hospital mortality after TV-TAVI and iSAVR was equal (2.7%) in 2017, despite the much higher risk profile of TV-TAVI patients. Using the AKL score as reference, TV-TAVI showed a more favourable observed-to-expected mortality (O/E) ratio (0.89) than iSAVR (1.14)- even more pronounced in patients at low risk (0.81 vs. 1.14).

Conclusions

The rates of major complications like bleeding and permanent pacemaker implantation after TV-TAVI keep declining. In 2017 patients undergoing TV-TAVI had a low in-hospital mortality rate with an O/E ratio < 1, indicating that the results were again better than those of all TAVI and SAVR of the previous year.

Graphic abstract

Overall in-hospital mortality after transvascular TAVI and isolated aortic valve repair 2017 in Germany stratified to risk groups by the German Aortic Valve Score (German AV Score/AKL Score): low risk group (AKL 0– < 3%), intermediate risk group (AKL 3– < 6%), high risk group (AKL 6– < 10%) and very high risk group (AKL ≥ 10%)

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Acknowledgements

We thank Elizabeth Martinson, PhD, of the KHFI Editorial Office for her editorial assistance. We thank Emilie Hofstetter for her assistance in analysing the data.

Funding

There was no funding for this work.

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Authors and Affiliations

  1. Department of Internal Medicine I, St. Johannes-Hospital Dortmund, Johannesstrasse 9-13, 44137, Dortmund, Germany

    Luise Gaede, Johannes Blumenstein, Oliver Husser, Jan Gülker & Helge Möllmann

  2. Medizinische Klinik 2, Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany

    Luise Gaede & Stephan Achenbach

  3. Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    Christoph Liebetrau, Won-Keun Kim, Holger Nef & Christian W. Hamm

  4. Medical Clinic I, Department of Cardiology and Angiology, University of Giessen, Giessen, Germany

    Christoph Liebetrau, Oliver Dörr, Won-Keun Kim, Holger Nef & Christian W. Hamm

  5. Department of Cardiology, Klinikum Oldenburg, Oldenburg, Germany

    Albrecht Elsässer

  6. German Center for Cardiovascular Research (DZHK), Partner SITE RhineMain, Bad Nauheim, Germany

    Christoph Liebetrau, Won-Keun Kim, Holger Nef & Christian W. Hamm

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  1. Luise Gaede
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Corresponding author

Correspondence to Helge Möllmann.

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Conflict of interest

Helge Möllmann received speaker honoraria and/or travel grants from Edwards Lifesciences, Abbott, Biotronik, Boston Scientific, St. Jude Medical, Symetis SA. Luise Gaede and Johannes Blumenstein report personal fees from Edwards Lifesciences, Abbott and Boston Scientific. Christian Hamm is advisor to Medtronic. Christoph Liebetrau reports personal fees from Abbott. Holger Nef reports personal fees from Boston Scientific. Won-Keun Kim reports personal fees from Boston Scientific, Abbott, Edwards Lifesciences, Medtronic. All other authors have no conflict of interest to declare.

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Gaede, L., Blumenstein, J., Liebetrau, C. et al. Transvascular transcatheter aortic valve implantation in 2017. Clin Res Cardiol 109, 303–314 (2020). https://doi.org/10.1007/s00392-019-01509-8

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