Temporal trends of TAVI treatment characteristics in high volume centers in Germany 2013–2020,Clinical Research in Cardiology

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Temporal trends of TAVI treatment characteristics in high volume centers in Germany 2013–2020
Clinical Research in Cardiology ( IF 5 ) Pub Date : 2021-11-09 , DOI: 10.1007/s00392-021-01963-3
Victor Mauri ₁ , Matti Adam ₁ , Stephan Baldus ₁ , Mohamed Abdel-Wahab ₂ , Holger Thiele ₂ , Sabine Bleiziffer ₃ , Verena Veulemans ₄ , Malte Kelm ₄ , Alexander Sedaghat ₅ , Georg Nickenig ₅ , Tanja K. Rudolph ₆

Affiliation

Objective

To assess temporal trends of patient baseline characteristics, risk profile and outcome of transcatheter aortic valve implantation (TAVI) between 2013 and 2020.

Background

Guideline recommendations and increasing confidence in TAVI therapy may have changed the selection of TAVI patients.

Methods

Baseline risk profile and VARC-2 outcome of 15,344 patients undergoing TAVI at 5 high volume centers in Germany over the time period 2013–2020 was analyzed.

Results

Over the 8 years, annual TAVI volumes more than doubled from 1071 in 2013 to 2996 in 2020. The baseline surgical risk estimated by the Society of Thoracic Surgeons (STS) score declined from 7.2 ± 6.2% to 4.6 ± 3.7% (P < 0.001) as a consequence of lower comorbidity burden, whereas mean age remained unchanged (2013 81.0 ± 6.1; 2020 80.8 ± 6.4; P = 0.976) with patients ≥ 80 years accounting for about two-third of the treated cohort.

Periprocedural complications including bleeding (2013 24.5%; 2020 12.1%; P < 0.001), vascular complications (2013 20.7%; 2020 11.7%; P < 0.001) and new permanent pacemaker implantation (2013 20.1%; 2020 13.8%, P < 0.001) decreased significantly. Similarly, the 30-day mortality decreased from 5.4% to 2.1% (P < 0.001), but remained high in high-risk patients (STS > 8% 2013 7.5%; 2020 6.9%; P = 0.778).

Conclusion

From 2013 to 2020, mortality and burden of complications following TAVI procedure significantly decreased in a large multicenter registry from Germany. Proportion of elderly patients remained stable, while the surgical risk profile decreased.

Graphical abstract

中文翻译：

2013-2020 年德国高容量中心 TAVI 治疗特征的时间趋势

客观的

评估 2013 年至 2020 年间经导管主动脉瓣植入术 (TAVI) 的患者基线特征、风险概况和结果的时间趋势。

背景

指南建议和对 TAVI 治疗信心的增加可能改变了 TAVI 患者的选择。

方法

分析了 2013-2020 年期间在德国 5 个高容量中心接受 TAVI 的 15,344 名患者的基线风险概况和 VARC-2 结果。

结果

8 年来，每年的 TAVI 量从 2013 年的 1071 次增加到 2020 年的 2996 次。根据胸外科医师协会 (STS) 评分估计的基线手术风险从 7.2 ± 6.2% 下降到 4.6 ± 3.7% ( P < 0.001 ) 由于合并症负担较低，而平均年龄保持不变（2013 年 81.0 ± 6.1；2020 年 80.8 ± 6.4；P = 0.976），≥ 80 岁的患者约占治疗队列的三分之二。

围手术期并发症，包括出血（2013 24.5％; 2020 12.1％; P <0.001），血管并发症（2013 20.7％; 2020 11.7％; P <0.001）和新永久性起搏器植入（2013 20.1％; 2020 13.8％，P <0.001 ) 显着下降。同样，30 天死亡率从 5.4% 降至 2.1% ( P < 0.001)，但在高危患者中仍然很高（STS > 8% 2013 7.5%；2020 6.9%；P = 0.778）。