title: In-hospital outcome of transcatheter vs. surgical aortic valve replacement in patients with aortic valve stenosis: complete dataset of patients treated in 2013 in Germany.
abstract: BACKGROUND
  Transvascular (TV-AVI) or transapical (TA-AVI) aortic valve implantation (TAVI) is a treatment option for patients with aortic stenosis being at high or prohibitive risk for surgical aortic valve implantation (SAVR). Randomized data demonstrated that these subgroups can safely been treated with TAVI. However, a comparison of SAVR and TAVI in intermediate and low-risk patients is missing. Therefore, the aim of the analysis was to compare TAVI and SAVR in all patients who were treated for aortic valve stenosis in Germany throughout 1 year.
  
  
  METHODS
  The mandatory quality assurance collects data on the in-hospital outcome from all patients (n = 20,340) undergoing either SAVR or TAVI in Germany. In order to compare the different treatment approaches patients were categorized into four risk groups using the logistic EuroScore I (ES). In-hospital mortality and peri- and postprocedural complications were analyzed.
  
  
  RESULTS
  The in-hospital mortality did not differ between TV-AVI and SAVR in the low risk group (ES <10 %: TV-AVI 2.4 %, SAVR 2.0 %, p = 0.302) and was significantly higher for SAVR in all other risk groups (ES 10-20 %: TV-AVI 3.5 %, SAVR 5.3 %; p = 0.025; ES 20-30 %: TV-AVI 5.5 %, SAVR 12.2 %, p < 0.001; ES >30 %: TV-AVI 6.5 %, SAVR 12.9 %, p = 0.008). TA-AVI had a significantly higher mortality in all risk groups compared to TV-AVI. In comparison to SAVR, TA-AVI had a higher mortality in patients with ES <10, comparable mortality in ES 10-20 %, and lower mortality in patients with an ES >20 %. The overall stroke rate was 2.3 %. It occurred more frequently in patients with an ES <10 % treated with a transapical approach (SAVR 1.8 %, TV-AVI 1.9 %, TA-AVI 3.1 %, p < 0.01). There were no statistically significant differences in all other comparisons.
  
  
  CONCLUSIONS
  This study demonstrates that TAVI provides excellent outcomes in all risk categories. Compared with SAVR, TV-TAVI yields similar in-hospital mortality among low-risk patients and lower in-hospital mortality among intermediate and high-risk patient populations.
authors.affiliation: Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany. moellmann@me.com.
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.affiliation: Institut für klinische Pharmakologie, TU Dresden, Dresden, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Bestehorn
authors.affiliation: Institut für klinische Pharmakologie, TU Dresden, Dresden, Germany.
authors.forename: Maike
authors.initials: M
authors.lastname: Bestehorn
authors.affiliation: Deutsche Gesellschaft für Kardiologie, Herz- und Kreislaufforschung, Düsseldorf, Germany.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papoutsis
authors.affiliation: Deutsche Gesellschaft für Kardiologie, Herz- und Kreislaufforschung, Düsseldorf, Germany.
authors.forename: Eckart
authors.initials: E
authors.lastname: Fleck
authors.affiliation: Department of Internal Medicine I, Cardiology, University Hospital Würzburg, Würzburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.affiliation: St. Georg Krankenhaus Hamburg, Hamburg, Germany.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.affiliation: Kerckhoff Heart Center, Benekestrasse 2-8, 61231, Bad Nauheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hamm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aortic stenosis; Aortic valve replacement; TAVI; TAVR; Transcatheter Aortic valve implantation
references.citation: N Engl J Med. 2011 Jun 9;364(23):2187-98
references.pmid: 21639811
references.citation: Eur J Cardiothorac Surg. 1999 Jun;15(6):816-22; discussion 822-3
references.pmid: 10431864
references.citation: Circulation. 2002 Dec 10;106(24):3006-8
references.pmid: 12473543
references.citation: Eur J Cardiothorac Surg. 2014 Nov;46(5):808-16
references.pmid: 25079769
references.citation: N Engl J Med. 2012 Jul 5;367(1):30-9
references.pmid: 22762316
references.citation: N Engl J Med. 2014 May 8;370(19):1790-8
references.pmid: 24678937
references.citation: Eur Heart J. 2014 Jun 21;35(24):1588-98
references.pmid: 24022003
references.citation: Eur Heart J. 2012 Apr;33(7):822-8, 828a, 828b
references.pmid: 21406443
references.citation: N Engl J Med. 2010 Oct 21;363(17):1597-607
references.pmid: 20961243
references.citation: J Card Surg. 2005 Nov-Dec;20(6):560-7
references.pmid: 16309412
references.citation: J Am Coll Cardiol. 2015 May 26;65(20):2173-80
references.pmid: 25787198
references.citation: N Engl J Med. 2012 May 3;366(18):1705-15
references.pmid: 22551129
references.citation: Ann Thorac Surg. 2009 Aug;88(2):468-74; discussion 474-5
references.pmid: 19632395
references.citation: Semin Thorac Cardiovasc Surg. 2011 Spring;23(1):55-61
references.pmid: 21807300
references.citation: Clin Res Cardiol. 2016 May;105(5):379-87
references.pmid: 26670909
references.citation: Eur J Cardiothorac Surg. 1999 Jul;16(1):9-13
references.pmid: 10456395
references.citation: EuroIntervention. 2012 May 15;8(1):129-38
references.pmid: 22391581
references.citation: Clin Res Cardiol. 2014 Jun;103(6):417-29
references.pmid: 24445751
references.citation: Eur Heart J. 2012 Oct;33(19):2451-96
references.pmid: 22922415
references.citation: Eur Heart J. 2005 Dec;26(24):2714-20
references.pmid: 16141261
references.citation: Clin Res Cardiol. 2012 Dec;101(12):993-1001
references.pmid: 22729757
references.citation: J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
references.pmid: 24603191
references.citation: Eur Heart J. 2009 Jan;30(1):74-80
references.pmid: 19033261
references.citation: Eur Heart J. 1987 May;8(5):471-83
references.pmid: 3609042
references.citation: Circulation. 2006 Feb 14;113(6):842-50
references.pmid: 16461813
references.citation: Ann Thorac Surg. 2009 May;87(5):1469-74
references.pmid: 19379886
references.citation: Clin Res Cardiol. 2015 Apr;104(4):363-5
references.pmid: 25475603