Transcatheter aortic valve replacement in Germany with need for a surgical bailout

IF 2.5 3区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of cardiology Pub Date : 2024-02-01 DOI:10.1016/j.jjcc.2024.01.003

Vera Oettinger MD, MSc , Ingo Hilgendorf MD , Dennis Wolf MD , Peter Stachon MD , Adrian Heidenreich MD , Manfred Zehender MD, PhD , Dirk Westermann MD , Klaus Kaier PhD , Constantin von zur Mühlen MD

{"title":"Transcatheter aortic valve replacement in Germany with need for a surgical bailout","authors":"Vera Oettinger MD, MSc , Ingo Hilgendorf MD , Dennis Wolf MD , Peter Stachon MD , Adrian Heidenreich MD , Manfred Zehender MD, PhD , Dirk Westermann MD , Klaus Kaier PhD , Constantin von zur Mühlen MD","doi":"10.1016/j.jjcc.2024.01.003","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>In transcatheter aortic valve replacement (TAVR), complications may force the need for a surgical bailout, but knowledge is rare about outcomes in Germany.</p></div><div><h3>Methods</h3><p>Using national health records, we investigated all TAVR in German hospitals between 2007 and 2020, focusing on 2018–2020. We extracted data on those interventions with need for a surgical bailout.</p></div><div><h3>Results</h3><p>A total of 159,643 TAVR were analyzed, with an overall rate of surgical bailout of 2.30 %, an overall in-hospital mortality of 3.85 %, and in-hospital mortality in case of bailout of 16.51 %. The number of all annual TAVR procedures increased substantially (202 to 22,972), with the rate of surgical bailout declining from 27.23 to 0.61 % and overall mortality from 11.39 to 2.29 %. However, in-hospital mortality after bailout was still high (28.37 % in 2020). The standardized rates of overall mortality and surgical bailout between 2018 and 2020 were significantly lower for balloon-expandable and self-expanding transfemoral TAVR than for transapical TAVR after risk adjustment [transapical/transfemoral balloon-expandable/transfemoral self-expanding TAVR: in-hospital mortality: 5.66 % (95 % CI 4.81 %; 6.52 %)/2.30 % (2.03 %; 2.57 %)/2.32 % (2.07 %; 2.57 %); surgical bailout: 2.33 % (1.68 %; 2.97 %)/0.79 % (0.60 %; 0.98 %)/0.42 % (0.31 %; 0.53 %)]. Coronary artery disease [risk-adjusted OR = 1.50 (1.21; 1.85), <em>p</em> < 0.001] and atrial fibrillation [OR = 1.29 (1.07; 1.57), <em>p</em> = 0.009] were found to be the main risk factors for bailout.</p></div><div><h3>Conclusions</h3><p>Rates of TAVR with need for a surgical bailout and overall in-hospital mortality have declined noticeably over the years in Germany. However, the outcomes are still unfavorable after surgical bailout, as in-hospital mortality is continuously high. We present risk factors for surgical bailout to improve preparation of subsequent measures. It must be a major goal to further reduce the rate of surgical bailouts in the future.</p></div>","PeriodicalId":15223,"journal":{"name":"Journal of cardiology","volume":"84 2","pages":"Pages 99-104"},"PeriodicalIF":2.5000,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0914508724000091/pdfft?md5=048b348e038f7318b7d50922566e8e36&pid=1-s2.0-S0914508724000091-main.pdf","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of cardiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0914508724000091","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}

引用次数: 0

Abstract

Background

In transcatheter aortic valve replacement (TAVR), complications may force the need for a surgical bailout, but knowledge is rare about outcomes in Germany.

Methods

Using national health records, we investigated all TAVR in German hospitals between 2007 and 2020, focusing on 2018–2020. We extracted data on those interventions with need for a surgical bailout.

Results

A total of 159,643 TAVR were analyzed, with an overall rate of surgical bailout of 2.30 %, an overall in-hospital mortality of 3.85 %, and in-hospital mortality in case of bailout of 16.51 %. The number of all annual TAVR procedures increased substantially (202 to 22,972), with the rate of surgical bailout declining from 27.23 to 0.61 % and overall mortality from 11.39 to 2.29 %. However, in-hospital mortality after bailout was still high (28.37 % in 2020). The standardized rates of overall mortality and surgical bailout between 2018 and 2020 were significantly lower for balloon-expandable and self-expanding transfemoral TAVR than for transapical TAVR after risk adjustment [transapical/transfemoral balloon-expandable/transfemoral self-expanding TAVR: in-hospital mortality: 5.66 % (95 % CI 4.81 %; 6.52 %)/2.30 % (2.03 %; 2.57 %)/2.32 % (2.07 %; 2.57 %); surgical bailout: 2.33 % (1.68 %; 2.97 %)/0.79 % (0.60 %; 0.98 %)/0.42 % (0.31 %; 0.53 %)]. Coronary artery disease [risk-adjusted OR = 1.50 (1.21; 1.85), p < 0.001] and atrial fibrillation [OR = 1.29 (1.07; 1.57), p = 0.009] were found to be the main risk factors for bailout.

Conclusions

Rates of TAVR with need for a surgical bailout and overall in-hospital mortality have declined noticeably over the years in Germany. However, the outcomes are still unfavorable after surgical bailout, as in-hospital mortality is continuously high. We present risk factors for surgical bailout to improve preparation of subsequent measures. It must be a major goal to further reduce the rate of surgical bailouts in the future.

Abstract Image

查看原文本刊更多论文

德国的经导管主动脉瓣置换术需要手术保驾护航

背景在经导管主动脉瓣置换术（TAVR）中，并发症可能会迫使患者进行手术保外治疗，但在德国有关手术效果的知识却很少。结果共分析了 159643 例 TAVR，总的手术保外率为 2.30%，总的院内死亡率为 3.85%，保外情况下的院内死亡率为 16.51%。所有年度TAVR手术数量大幅增加（从202例增至22972例），手术保外率从27.23%降至0.61%，总死亡率从11.39%降至2.29%。然而，保外手术后的院内死亡率仍然很高（2020 年为 28.37%）。经风险调整后，2018 年至 2020 年期间球囊扩张型和经股动脉自扩张型 TAVR 的总死亡率和手术保送的标准化比率显著低于经心尖 TAVR [经心尖 / 经股动脉球囊扩张型 / 经股动脉自扩张型 TAVR：院内死亡率：5.66 % (95 % CI 4.81 %; 6.52 %) / 2.30 % (2.03 %; 2.57 %) / 2.32 % (2.07 %; 2.57 %)；手术保外：2.33 % (1.68 %; 2.97 %) / 0.79 % (0.60 %; 0.98 %) / 0.42 % (0.31 %; 0.53 %)]。冠状动脉疾病[风险调整 OR = 1.50 (1.21; 1.85)，p < 0.001]和心房颤动[OR = 1.29 (1.07; 1.57)，p = 0.009]是保外手术的主要风险因素。然而，由于院内死亡率居高不下，手术保外治疗后的结果仍然不容乐观。我们提出了手术保外的风险因素，以改进后续措施的准备工作。今后，进一步降低手术保送率必须成为一个主要目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.90

自引率

8.00%

发文量

202

审稿时长

29 days

期刊介绍： The official journal of the Japanese College of Cardiology is an international, English language, peer-reviewed journal publishing the latest findings in cardiovascular medicine. Journal of Cardiology (JC) aims to publish the highest-quality material covering original basic and clinical research on all aspects of cardiovascular disease. Topics covered include ischemic heart disease, cardiomyopathy, valvular heart disease, vascular disease, hypertension, arrhythmia, congenital heart disease, pharmacological and non-pharmacological treatment, new diagnostic techniques, and cardiovascular imaging. JC also publishes a selection of review articles, clinical trials, short communications, and important messages and letters to the editor.