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Circulation. 2018 Dec 4;138(23):2611-2623. doi: 10.1161/CIRCULATIONAHA.117.033048.

Patients at Intermediate Surgical Risk Undergoing Isolated Interventional or Surgical Aortic Valve Implantation for Severe Symptomatic Aortic Valve Stenosis.

Author information

1
Medizinische Klinik B, Klinikum Ludwigshafen, Germany (N.W., R.Z.).
2
Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie, Langenbeck-Virchow-Haus Berlin, Germany (A. Beckmann).
3
Kardiologie-Angiologie, Universitätsklinikum Gießen, Germany (T.B., C.W.H.).
4
Klinik für Herz- und Gefäßchirurgie, Deutsches Herzzentrum München, Germany (S.B., R.L.).
5
Kardiologie, Kerckhoff Klinik, Bad Nauheim, Germany (C.W.H., A. Berkowitsch).
6
Klinik für Kardiologie, Angiologie, Pneumologie, Universitätsklinikum Heidelberg, Germany (R.B., H.A.K.).
7
Herzzentrum Leipzig, Universitätsklinik Leipzig, Germany (F.W.M.).
8
Bundesgeschäftsstelle Qualitätssicherung Institut für Qualität und Patientensicherheit GmbH, Düsseldorf, Germany (S.L.).
9
Herzchirurgie, Klinikum Braunschweig, Germany (W.H.).
10
Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum Nordrhein-Westfalen, Universitätsklinik der Ruhr-Universität Bochum, Bad Oeynhausen, Germany (S.E.).
11
Kardiologie, Asklepios Klinik St. Georg, Hamburg, Germany (C.F.).
12
Klinik für Innere Medizin I, St.-Johannes-Hospital Dortmund, Germany (H.M.).
13
Herzchirurgie, Kerckhoff Klinik, Bad Nauheim, Germany (T.W.).
14
Institut für Herzinfarktforschung, Ludwigshafen, Germany (S.S.).

Abstract

BACKGROUND:

Transcatheter aortic valve replacement (TAVR) is increasingly being used for treatment of severe aortic valve stenosis in patients at intermediate risk for surgical aortic valve replacement (SAVR). Currently, real-world data comparing indications and clinical outcomes of patients at intermediate surgical risk undergoing isolated TAVR with those undergoing SAVR are scarce.

METHODS:

We compared clinical characteristics and outcomes of patients with intermediate surgical risk (Society of Thoracic Surgeons score 4%-8%) who underwent isolated TAVR or conventional SAVR within the prospective, all-comers German Aortic Valve Registry.

RESULTS:

A total of 7613 patients at intermediate surgical risk underwent isolated TAVR (n=6469) or SAVR (n=1144) at 92 sites in Germany between 2012 and 2014. Patients treated by TAVR were significantly older (82.5±5.0 versus 76.6±6.7 years, P<0.001) and had higher risk scores (logistic EuroSCORE [European System for Cardiac Operative Risk Evaluation]: 21.2±12.3% versus 14.2±9.5%, P<0.001; Society of Thoracic Surgeons score: 5.6±1.1 versus 5.2±1.0, P<0.001). Multivariable analyses revealed that advanced age, coronary artery disease, New York Heart Association class III/IV, pulmonary hypertension, prior cardiac decompensation, elective procedure, arterial occlusive disease, no diabetes mellitus, and a smaller aortic valve area were associated with performing TAVR instead of SAVR (all P<0.001). Unadjusted in-hospital mortality rates were equal for TAVR and SAVR (3.6% versus 3.6%, P=0.976), whereas unadjusted 1-year mortality was significantly higher in patients after TAVR (17.5% versus 10.8%, P<0.001). After propensity score matching, the difference in 1-year mortality between patients with TAVR and SAVR was no longer significant (17.1% versus 15.7%, P=0.59).

CONCLUSIONS:

Patients at intermediate risk undergoing TAVR differ significantly from those treated with SAVR with regard to age and baseline characteristics. Isolated TAVR and SAVR were associated with an in-hospital mortality rate of 3.6%. In the propensity score analysis, there was no significant difference in 1-year mortality between patients with TAVR and SAVR.

KEYWORDS:

aortic valve; registries; risk factors; transcatheter aortic valve replacement

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