Gaede Luise, Blumenstein Johannes, Kim Won-Keun, Liebetrau Christoph, Dörr Oliver, Nef Holger, Hamm Christian, Elsässer Albrecht, Möllmann Helge
Department of Internal Medicine, St. Johannes-Hospital, Johannesstrasse 9-13, 44137, Dortmund, Germany.
Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany.
Clin Res Cardiol. 2017 Jun;106(6):411-419. doi: 10.1007/s00392-016-1070-1. Epub 2017 Jan 11.
We analysed the number of procedures, indications, and in-hospital mortality rates of all patients undergoing isolated surgical aortic valve replacement (sAVR) or transvascular (TV-) and transapical (TA-) transcatheter aortic valve implantation (TAVI) from 2012 to 2015 in Germany.
More than 31,000 aortic valve procedures were performed in 2015 in Germany, representing a total increase of 4.5% over 2014. TV-TAVI accounts for 13,108 of these procedures, with an increase of 21%, whereas the numbers of isolated sAVR and TA-TAVI decreased slightly. Age, frailty, high risk, and patients' choice were the main reasons for a catheter-based intervention. In 2015, the in-hospital mortality rate after TV-TAVI decreased to 3.4%, approaching that of sAVR (2.9%), despite a considerably higher baseline risk. A stratified analysis according to the German aortic valve (AKL) score demonstrated a further decrease of the in-hospital mortality for TV-TAVI, showing a lower in-hospital mortality rate than expected in all risk groups. Importantly, this also accounts for the lowest risk group with an AKL score <3% showing an in-hospital mortality rate of 1.7%, which is now comparable to that of sAVR (1.5%). In all other risk groups, the in-hospital mortality in patients undergoing TV-TAVI was lower than in patients undergoing sAVR.
Mortality after TV-TAVI keeps decreasing over the last years and equals that of SAVR in the lowest risk cohort in the meanwhile. All TV-TAVI patients have significantly lower observed than expected mortality, which will further lead to a redefinition of standard of care.
我们分析了2012年至2015年在德国接受单纯外科主动脉瓣置换术（sAVR）或经血管（TV-）及经心尖（TA-）经导管主动脉瓣植入术（TAVI）的所有患者的手术数量、适应证及院内死亡率。
2015年德国进行了超过31000例主动脉瓣手术，较2014年总体增长了4.5%。其中TV-TAVI手术有13108例，增长了21%，而单纯sAVR和TA-TAVI的数量略有下降。年龄、身体虚弱、高风险以及患者的选择是采用基于导管干预的主要原因。2015年，TV-TAVI术后院内死亡率降至3.4%，尽管基线风险明显更高，但已接近sAVR（2.9%）。根据德国主动脉瓣（AKL）评分进行的分层分析显示，TV-TAVI的院内死亡率进一步降低，在所有风险组中其院内死亡率均低于预期。重要的是，AKL评分<3%的最低风险组的院内死亡率为1.7%，现已与sAVR（1.5%）相当。在所有其他风险组中，接受TV-TAVI患者的院内死亡率低于接受sAVR的患者。
在过去几年中，TV-TAVI术后死亡率持续下降，同时在最低风险队列中与SAVR相当。所有TV-TAVI患者的实际观察到的死亡率显著低于预期，这将进一步导致对医疗标准的重新定义。
