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N Engl J Med. 2015 Dec 17;373(25):2438-47. doi: 10.1056/NEJMoa1500893.

Effect of Availability of Transcatheter Aortic-Valve Replacement on Clinical Practice.

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From the Departments of Cardiology and Angiology I ( J.R., K.K., C.B., M.Z.) and Cardiovascular Surgery (F.B.), Heart Center, and Center for Medical Biometry and Medical Informatics (K.K., W.V.) and Clinical Trials Unit (C.S.), Medical Center, University of Freiburg, Freiburg, Project Group Diagnosis Related Groups, German Cardiac Society, Duesseldorf ( J.R., H.R., L.F.), Department of Cardiovascular Medicine, Division of Vascular Medicine, University Hospital Muenster, Muenster (H.R.), and Department of Cardiology, Angiology, and Pulmonology, University of Heidelberg, Heidelberg (L.F.) - all in Germany; and the Department of Cardiology, Rouen University Hospital Charles Nicolle, Rouen, France (A.C.).



Since the adoption of transcatheter aortic-valve replacement (TAVR), questions have been raised about its effect on clinical practice in comparison with the effect of surgical aortic-valve replacement, which is considered the current standard of care. Complete nationwide data are useful in examining how the introduction of a new technique influences previous clinical standards.


We analyzed data on characteristics of patients and in-hospital outcomes for all isolated TAVR and surgical aortic-valve replacement procedures performed in Germany from 2007 to 2013.


In total, 32,581 TAVR and 55,992 surgical aortic-valve replacement procedures were performed. The number of TAVR procedures increased from 144 in 2007 to 9147 in 2013, whereas the number of surgical aortic-valve replacement procedures decreased slightly, from 8622 to 7048. Patients undergoing TAVR were older than those undergoing surgical aortic-valve replacement (mean [±SD] age, 81.0±6.1 years vs. 70.2±10.0 years) and at higher preoperative risk (estimated logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation], 22.4% vs. 6.3%, on a scale of 0 to 100%, with higher scores indicating greater risk and a score of more than 20% indicating high surgical risk). In-hospital mortality decreased in both groups between 2007 and 2013 (from 13.2% to 5.4% with TAVR and from 3.8% to 2.2% with surgical aortic-valve replacement). The incidences of stroke, bleeding, and pacemaker implantation (but not acute kidney injury) also declined.


The use of TAVR increased markedly in Germany between 2007 and 2013; the concomitant reduction in the use of surgical aortic-valve replacement was moderate. Patients undergoing TAVR were older and at higher procedural risk than those undergoing surgical aortic-valve replacement. In-hospital mortality decreased in both groups but to a greater extent among patients undergoing TAVR. (Funded by the Heart Center, Freiburg University.).

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