Development and Results of Transcatheter and Surgical Aortic ValveReplacement in Germany 2014 and 2015

Abstract

Treatment of aortic valve stenosis has been changing since the introduction of transcatheter aortic valve replacement (TAVR). The present study investigates the treatment of aortic valve stenosis in a real-world population 2014 and 2015 in Germany. Patient characteristics and in-hospital outcomes of all 38 414 isolated surgical aortic valve replacements (SAVR) or TAVR were analyzed. Since 2014 more TAVR than SAVR were performed in Germany. Overall interventions on the aortic valve increases: from 10 858 in 2009 to 19 929 in 2015. In 2015 patients > 75 were mainly treated with transfemoral (TF) TAVR. SAVR was performed in 474 patients over 80 years (for comparison: TF-TAVR: 7519; transapical (TA) TAVR: 1192). Patients treated with TAVR were older, more often female, and had more co-morbidities. Consequently, they were at higher operative risk. Overall in-hospital mortality was 2 % after SAVR, 3 % after TF-TAVR, and 6 % after TA-TAVR. Stroke rates were similar. Relevant bleeding events occurred after SAVR and TA-TAVR in 9 % and 8 % respectively and 3 % after TF-TAVR. 66 % of patients after TF-TAVR and 40 % after SAVR were discharged home. TF-TAVR has become the most often performed therapy for patients > 75. Despite a higher operative risk, patients can be treated safely with TF-TAVR.