Department of Internal Medicine, St.-Johannes-Hospital, Johannesstraße 9-13, 44137 Dortmund, Germany.
Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestraße 2-8, 61231 Bad Nauheim, Germany.
Eur Heart J. 2018 Feb 21;39(8):667-675. doi: 10.1093/eurheartj/ehx688.
We analysed the number of procedures, complications, and in-hospital mortality rates of all patients undergoing transvascular transcatheter aortic valve implantation (TV-TAVI) in comparison to isolated surgical aortic valve replacement (iSAVR) from 2014 to 2016 in Germany.
All aortic valve procedures performed in Germany are mandatorily registered in a quality control program. More than 15 000 TV-TAVI procedures were performed in 2016 in Germany. Especially the number of post-procedural complications declined within the last few years, including new pacemaker implantations (2015: 12.6% vs. 2016: 11.4%, P = 0.002) and vascular complications (2015: 8.5% vs. 2016: 7.1%; P < 0.001). Thus, in 2016 the overall in-hospital mortality rate after TV-TAVI was 2.6%, which is for the first time numerically below that of iSAVR, which was 2.9% (P = 0.19). A stratified analysis according to the German aortic valve score shows a lower observed than expected in-hospital mortality rate for TV-TAVI (O/E 0.68). Additionally, the in-hospital mortality was significantly lower after TV-TAVI than after iSAVR in the very high- (11.3% vs. 23.6%; P < 0.001), in the high- (4.1% vs. 9.2%; P < 0.001), and in the intermediate-risk group (3.0% vs. 4.6%; P = 0.016) and was similar to that of iSAVR in low-risk patients (1.6% vs. 1.4%; P = 0.4).
The overall in-hospital mortality after TV-TAVI was numerically lower than after iSAVR in 2016 for the first time. In the low risk group in-hospital mortality was similar, whereas in all other risk groups in-hospital mortality after TV-TAVI was significantly lower than after SAVR. This is likely to contribute to a redefinition of the standard of care in the future.
我们分析了 2014 年至 2016 年德国所有接受经导管经血管主动脉瓣置换术（TV-TAVI）的患者与单纯外科主动脉瓣置换术（iSAVR）的手术数量、并发症发生率和院内死亡率。
德国所有主动脉瓣手术都必须在质量控制计划中进行强制性登记。2016 年，德国共进行了超过 15000 例 TV-TAVI 手术。特别是在过去几年中，术后并发症的数量有所下降，包括新的起搏器植入（2015 年：12.6%比 2016 年：11.4%，P=0.002）和血管并发症（2015 年：8.5%比 2016 年：7.1%；P<0.001）。因此，2016 年 TV-TAVI 术后的院内总体死亡率为 2.6%，首次低于 iSAVR 的 2.9%（P=0.19）。根据德国主动脉瓣评分进行分层分析显示，TV-TAVI 的观察到的院内死亡率低于预期（O/E 0.68）。此外，TV-TAVI 的院内死亡率明显低于 iSAVR，在极高危（11.3%比 23.6%；P<0.001）、高危（4.1%比 9.2%；P<0.001）和中危组（3.0%比 4.6%；P=0.016），与低危患者的 iSAVR 相似（1.6%比 1.4%；P=0.4）。
2016 年，TV-TAVI 的总体院内死亡率首次低于 iSAVR。在低危组中，院内死亡率相似，而在所有其他风险组中，TV-TAVI 的院内死亡率明显低于 iSAVR。这可能有助于未来重新定义治疗标准。
