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Eur Heart J. 2018 Nov 16. doi: 10.1093/eurheartj/ehy699. [Epub ahead of print]

Patients at low surgical risk as defined by the Society of Thoracic Surgeons Score undergoing isolated interventional or surgical aortic valve implantation: in-hospital data and 1-year results from the German Aortic Valve Registry (GARY).

Author information

Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, Heidelberg 69120, Germany.
Department of Cardiology, Robert-Bosch-Hospital Stuttgart, Auerbachstrasse 110, Stuttgart 70376, Germany.
Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 110, Heidelberg 69120, Germany.
Institute of Biostatistics and Mathematical Modelling, Goethe-University Frankfurt, Theodor-Stern-Kai 7, Frankfurt, Germany.
German Center for Cardiovascular Research, DZHK, Partner Site Heidelberg, Theodor-Stern-Kai 7, Frankfurt D-60590, Germany.
Department of Cardiovascular Surgery, German Heart Center Munich, Technische Universität, Lazarettstr. 36, 80636 Munich, Gemany.
Department of Cardiology, University Hospital Gießen, Klinikstrasse 33, Gießen 35392, Germany.
Department of Cardiac Surgery, University of Lübeck, Ratzeburger Allee 160, Lübeck 23538, Germany.
Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, Hamburg 20099, Germany.
Department of Cardiovascular Surgery, University of Freiburg, Hugstetter Strasse 55, Freiburg 79106, Germany.
Department of Cardiology, Kerckhoff Klinik Bad Nauheim, Benekestr. 2-8, Bad Nauheim 61231, Germany.
German Society for Thoracic and Cardiovascular Surgery, Langenbeck-Virchow-Haus, Luisenstr. 58-59, Berlin 10117, Germany.
Department of Cardiology, St.-Johannes Hospital Dortmund, Johannesstrasse 9-17, Dortmund 44137, Germany.
Department of Cardiothoracic Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, Frankfurt D-60590, Germany.



Transcatheter aortic valve implantation (TAVI) has become the standard treatment for patients with severe aortic valve stenosis at high surgical risk and may be considered for patients with intermediate risk. During the last few years, an increasing number of patients with low surgical risk have been treated with TAVI. In this study, low-risk patients undergoing isolated TAVI or surgical aortic valve replacement (SAVR) were analysed using data from the German Aortic Valve Registry (GARY).

Methods and results:

All patients with a Society of Thoracic Surgeons Score of <4% undergoing TAVI or SAVR in 2014 and 2015 were evaluated. A total of 20 549 low surgical risk patients remained for further analysis, comprising 14 487 surgical patients and 6062 TAVI patients. Since TAVI patients were significantly older and had significantly more co-morbidities, a weighted propensity score model was used to compare SAVR and TAVI patients for in-hospital, 30-day, and 1-year mortality. Transcatheter aortic valve implantation patients showed a significantly higher in-hospital and 30-day survival than SAVR patients (in hospital survival TAVI vs. SAVR: 98.5% vs. 97.3%; P = 0.003; 30-day survival TAVI vs. SAVR: 98.1% vs. 97.1%; P = 0.014). At 1 year, survival rates did not differ significantly (survival TAVI vs. SAVR: 90.0% vs. 91.2%; P = 0.158).


In this first GARY analysis of low-risk patients, weighted comparison showed similar 1-year survival for TAVI and SAVR and higher in-hospital survival for TAVI patients.


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