title: Perioperative Results and Complications in 15,964 Transcatheter Aortic Valve Replacements: Prospective Data From the GARY Registry.
abstract: BACKGROUND
  Transcatheter aortic valve replacement (TAVR) has evolved into a routine procedure with good outcomes in high-risk patients.
  
  
  OBJECTIVE
  TAVR complication rates were evaluated based on prospective data from the German Aortic Valve Registry (GARY).
  
  
  METHODS
  From 2011 to 2013, a total of 15,964 TAVR procedures were registered. We evaluated the total cohort for severe vital complications (SVCs), including the following: death on the day of intervention, conversion to sternotomy, low cardiac output that required mechanical support, aortic dissection, and annular rupture; technical complications of the procedures (TCOs), such as repositioning or retrieval of the valve prosthesis and embolization of the prosthesis; and other complications.
  
  
  RESULTS
  Mean patient age was 81 ± 6 years, 54% of the patients were women, the median logistic Euroscore I was 18.3, the German aortic valve score was 5.6, and the Society of Thoracic Surgeons score was 5.0. Overall in-hospital mortality was 5.2%, whereas SVCs occurred in 5.0% of the population. Independent predictors for SVCs were female sex, pre-operative New York Heart Association functional class IV, ejection fraction <30%, pre-operative intravenous inotropes, arterial vascular disease, and higher degree of calcifications. TCOs occurred in 4.7% of patients and decreased significantly from 2011 to 2013. An emergency sternotomy was performed in 1.3% of the patients; however, multivariate analysis did not identify any predictors for conversion to sternotomy.
  
  
  CONCLUSIONS
  The all-comers GARY registry revealed good outcomes after TAVR and a regression in complications. Survival of approximately 60% of patients who experienced SVCs or who required sternotomy underlines the need for heart team-led indication, intervention, and follow-up care of TAVR patients.
authors: Kerckhoff Herzzentrum, Abteilung Herzchirurgie, Bad Nauheim, Germany. Electronic address: t.walther@kerckhoff-klinik.de.
authors: Thomas
authors: T
authors: Walther
authors: Kerckhoff Herzzentrum, Abteilung Kardiologie, Bad Nauheim, Germany.
authors: Christian W
authors: CW
authors: Hamm
authors: Herzzentrum Leipzig, Abteilung Kardiologie, Leipzig, Germany.
authors: Gerhard
authors: G
authors: Schuler
authors: Kerckhoff Herzzentrum, Abteilung Kardiologie, Bad Nauheim, Germany.
authors: Alexander
authors: A
authors: Berkowitsch
authors: BQS Institute, Düsseldorf, Germany.
authors: Joachim
authors: J
authors: Kötting
authors: Herzzentrum Leipzig, Abteilung Kardiologie, Leipzig, Germany.
authors: Norman
authors: N
authors: Mangner
authors: Städtisches Klinikum Munich, Klinikum Neuperlach, Department of Cardiology/Pneumology, Munich, Germany.
authors: Harald
authors: H
authors: Mudra
authors: Deutsche Gesellschaft für Thorax-, Herz-, und Gefässchirurgie, Berlin, Germany.
authors: Andreas
authors: A
authors: Beckmann
authors: Universität Kiel, Abteilung für Herzchirurgie, Kiel, Germany.
authors: Jochen
authors: J
authors: Cremer
authors: Universität Bonn, Abteilung Herzchirurgie, Bonn, Germany.
authors: Armin
authors: A
authors: Welz
authors: Deutsches Herzzentrum München, Abteilung Herzchirurgie, München, Germany.
authors: Rüdiger
authors: R
authors: Lange
authors: St. Georg Krankenhaus, Abteilung Kardiologie, Hamburg, Germany.
authors: Karl-Heinz
authors: KH
authors: Kuck
authors: Herzzentrum Leipzig, Abteilung Herzchirurgie, Leipzig, Germany.
authors: Friedrich W
authors: FW
authors: Mohr
authors: Kerckhoff Herzzentrum, Abteilung Kardiologie, Bad Nauheim, Germany.
authors: Helge
authors: H
authors: Möllmann
mesh_terms: D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
keywords: TAVR; aortic stenosis; conversion; heart team