Analyzing current German transcatheter and surgical aortic valve replacement practices in pure aortic regurgitation

Abstract

Abstract Background In Germany, the use of transcatheter aortic valve replacement (TAVR) for treating pure aortic regurgitation is still not regular practice. Purpose Therefore, the current development of TAVR in aortic regurgitation is to be investigated. Methods In 2018–2020, 4,025 surgical aortic valve replacements (SAVR), 50 transapical, 329 balloon-expandable transfemoral, and 457 self-expanding transfemoral TAVR in pure aortic regurgitation were studied using multivariable logistic and linear regressions. Results The TAVR groups had a higher age than SAVR (76.0-77.3a vs 62.8a) and logistic EuroSCORE (17.7-19.1 vs 4.9%). Unadjusted in-hospital mortality was highest in transapical TAVR (6.0%), followed by SAVR (5.7%), and it was lowest in transfemoral TAVR, with self-expanding procedures (2.4%) showing significantly lower in-hospital mortality than balloon-expandable (5.2%; p=0.039). After risk adjustment, we saw a significant association with lower mortality rates for balloon-expandable as well as self-expanding transfemoral TAVR vs SAVR (balloon-expandable: OR=0.50, p=0.031; self-expanding: OR=0.20, p<0.001). In the same way, we found that other examined outcomes were significantly in favor of TAVR: stroke (balloon-expandable: OR=0.17, p<0.001; self-expanding: OR=0.17, p<0.001), major bleeding (balloon-expandable: OR=0.04, p<0.001; self-expanding: OR=0.03, p<0.001), delirium (balloon-expandable: OR=0.19, p<0.001; self-expanding: OR=0.16, p<0.001), mechanical ventilation >48h (balloon-expandable: OR=0.09, p<0.001; self-expanding: OR=0.06, p<0.001), and length of hospital stay (balloon-expandable: Coefficient=-6.88d, p<0.001; self-expanding: Coefficient=-7.22d, p<0.001). Conclusion Despite lower procedure volumes in TAVR vs SAVR for pure aortic regurgitation, we see lower rates of in-hospital mortality and complications, suggesting that TAVR can be used successfully in selected patients with aortic regurgitation.