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Temporal trends in transcatheter and surgical aortic valve replacement

An analysis of aortic valve replacements in Germany during 2012–2014

Ergebnisse nach kathetergestützten und chirurgischen Aortenklappenimplantationen

Eine Analyse der Aortenklappenimplantationen in Deutschland von 2012 bis 2014

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Abstract

This analysis of the data of the obligatory quality assurance programme AQUA shows the perioperative risk as well as the procedural outcome evaluated by the observed versus expected in-hospital mortality ratio (O/E ratio) of 62,872 patients undergoing isolated surgical (sAVR), transcatheter transvascular (TV-), or transapical (TA-) aortic valve replacement (TAVI) from 2012 to 2014 in Germany. The number of TAVI procedures increased from 9,352 in 2012 to 13,278 in 2014, whereas the number of sAVR remained constant (2012: 9,949; 2014: 9,953). Between 2012 and 2014, the number of TAVI implanted in patients with a logistic EuroScore I (logESI) of ≤10 % (2012: 21 %; 2014: 26 %) as well as with a logESI <20 % (2012: 57 %; 2014: 64 %) increased. In-hospital mortality in TAVI patients decreased from 5.2 % (TV: 5.0 %; TA: 7.4 %) in 2012 to 4.2 % (TV: 3.8 %; TA: 5.5 %) in 2014, whereas it was stable for sAVR patients (2012: 2.8 %; 2014: 2.6 %). The O/E ratio of TAVI patients decreased from 0.91 (TV: 0.79; TA: 1.2) to 0.73 (TV: 0.69; TA: 0.89), whereas this ratio remained constant for sAVR patients (2012: 0.92; 2014: 0.93). In summary, estimated surgical risk, in-hospital mortality, as well as the O/E ratio for patients undergoing TAVI declined constantly during the last 3 years.

Zusammenfassung

Die Analyse aus Daten der verpflichtenden Qualitätssicherung (AQUA) zeigt die perioperativen Risiken sowie das postprozedurale Ergebnis von 62.872 Patienten, die in Deutschland zwischen 2012 und 2014 eine kathetergestützten (TAVI) oder einen isolierten chirurgischen Aortenklappenersatz (AKE) erhielten. Die Anzahl der TAVI stieg von 9352 im Jahr 2012 auf 13.278 im Jahr 2014, während die Zahl der AKE-Operationen konstant blieb (2012: 9949, 2014: 9953). Seit 2012 sind zunehmend Patienten mit niedrigerem Risiko durch TAVI behandelt worden (logistischer EuroScore I (logESI) ≤10 % im Jahr 2012: 21 %; im Jahr 2014: 26 %; logESI <20 % im Jahr 2012: 57 %; im Jahr 2014: 64 %). Die Krankenhaussterblichkeit nach TAVI nahm stetig ab, sie lag 2012 bei 5,2 % (transvaskulär, TV: 5,0 %; transapikal, TA: 7,4 %) und betrug 2014 nur 4,2 % (TV: 3,8 %; TA: 5,5 %), während sie nach AKE konstant blieb (2012: 2,8 %; 2014: 2,6 %). Noch eindrücklicher ist das Verhältnis von beobachteten zu erwarteten Todesfällen (O/E-Verhältnis), das bei TAVI-Patienten drastisch abnahm – von 0,91 im Jahr 2012 (TV: 0,79; TA: 1,2) auf 0,73 im Jahr 2014 (TV: 0,69; TA: 0,89) –, wohingegen es nach AKE konstant blieb (im Jahr 2012: 0,92; im Jahr 2014: 0,93). Zusammenfassend lässt sich sowohl eine Abnahme des geschätzten perioperativen Risikos als auch der Krankenhaussterblichkeit bei TAVI-Patienten feststellen. Von größter Bedeutung ist die sehr vorteilhafte Verbesserung des O/E-Verhältnisses, das 2014 über 20 % niedriger zugunsten der TAVI-Prozedur im Vergleich zur AKE-Operation ausfiel. Diese positive Entwicklung war unabhängig vom zugrunde liegenden Operationsrisiko.

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Authors and Affiliations

  1. Dept. of Internal Medicine, St. Johannes-Hospital, Johannesstraße 9–13, 44137, Dortmund, Germany

    L. Gaede, J. Blumenstein & H. Möllmann

  2. Dept. of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    W.-K. Kim, C. Liebetrau & C. Hamm

  3. Medical Clinic II. Dept. of Cardiology and Angiology, Friedrich Alexander Universität Erlangen-Nürnberg, Erlangen, Germany

    L. Gaede & S. Achenbach

  4. Dept. of Cardiac Surgery, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany

    W.-K. Kim & T. Walther

  5. Medical Clinic I, Dept. of Cardiology and Angiology, University of Giessen, Giessen, Germany

    O. Dörr, H. Nef & C. Hamm

  6. Dept. of Cardiology, Klinikum Oldenburg, Oldenburg, Germany

    A. Elsässer

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  1. L. Gaede
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  2. W.-K. Kim
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  7. C. Hamm
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Correspondence to H. Möllmann.

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Conflict of interest

L. Gaede, K. Won-Keun, J. Blumenstein, C. Liebetrau, O. Dörr, H. Nef, C. Hamm, T. Walther, S. Achenbach, A. Elsässer and H. Möllmann state that they have no competing interest.

This article does not contain any studies with human participants or animals performed by any of the authors.

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Gaede, L., Kim, WK., Blumenstein, J. et al. Temporal trends in transcatheter and surgical aortic valve replacement. Herz 42, 316–324 (2017). https://doi.org/10.1007/s00059-016-4461-1

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