Transcatheter aortic valve replacement in Germany with need for a surgical bailout.
J Cardiol
; 84(2): 99-104, 2024 Aug.
Article
en En
| MEDLINE
| ID: mdl-38307247
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 2.30â¯%, an overall in-hospital mortality of 3.85â¯%, and in-hospital mortality in case of bailout of 16.51â¯%. The number of all annual TAVR procedures increased substantially (202 to 22,972), with the rate of surgical bailout declining from 27.23 to 0.61â¯% and overall mortality from 11.39 to 2.29â¯%. However, in-hospital mortality after bailout was still high (28.37â¯% 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 5.66â¯% (95â¯% CI 4.81â¯%; 6.52â¯%)/2.30â¯% (2.03â¯%; 2.57â¯%)/2.32â¯% (2.07â¯%; 2.57â¯%); surgical bailout 2.33â¯% (1.68â¯%; 2.97â¯%)/0.79â¯% (0.60â¯%; 0.98â¯%)/0.42â¯% (0.31â¯%; 0.53â¯%)]. Coronary artery disease [risk-adjusted ORâ¯=â¯1.50 (1.21; 1.85), pâ¯<â¯0.001] and atrial fibrillation [ORâ¯=â¯1.29 (1.07; 1.57), pâ¯=â¯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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
Problema de salud:
1_sistemas_informacao_saude
Asunto principal:
Estenosis de la Válvula Aórtica
/
Mortalidad Hospitalaria
/
Reemplazo de la Válvula Aórtica Transcatéter
Tipo de estudio:
Risk_factors_studies
Límite:
Aged
/
Aged80
/
Female
/
Humans
/
Male
País/Región como asunto:
Europa
Idioma:
En
Revista:
J Cardiol
Asunto de la revista:
CARDIOLOGIA
Año:
2024
Tipo del documento:
Article