Clin Res Cardiol (2021). 10.1007/s00392-021-01933-9

Emergency transcatheter aortic valve implantations: Volume-outcome relationship in Germany
V. Oettinger1, M. Zehender1, C. Bode1, C. von zur Mühlen1, K. Kaier2, P. Stachon1
1Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH, Freiburg im Breisgau; 2Institut für Medizinische Biometrie und Statistik, Universitätsklinikum Freiburg, Freiburg im Breisgau;

Background: Literature showed an inverse volume-outcome relationship in transcatheter aortic valve implantation (TAVI) but little is known about emergency cases.

Methods: Using German national records, all balloon-expandable and self-expanding transfemoral TAVI in 2018 were identified. Furthermore, those patients with emergency admission were extracted.

Results: Of overall 17,295 patients, 1,682 had an emergency admission. Of the latter, 49.2% were female, mean age was 81.2 years and logistic EuroSCORE 23.3%. In-hospital mortality was 3.57%, major bleeding 3.27%, stroke 1.90%, acute kidney injury 15.04%, delirium 10.11%, permanent pacemaker implantation 13.85%, mechanical ventilation >48h 2.00%, mean length of hospital stay 17.75 days, and mean reimbursement €29,917. Lower volume (LV) centers treated relatively more emergency cases than higher volume (HV) centers (p<0.001): In detail, centers conducting less than 50 TAVI procedures were associated with an emergency admission rate of ~15% while centers conducting more than 200 TAVI procedures had an emergency admission rate of ~11%. After propensity score adjustment, HV centers had significantly better outcomes vs LV centers for in-hospital mortality (p=0.043), major bleeding (p=0.001), stroke (p=0.044), mechanical ventilation >48h (p=0.001), length of hospital stay (p<0.001), and reimbursement (p<0.001). No relationship was seen in acute kidney injury (p=0.104), postoperative delirium (p=0.480), and permanent pacemaker implantation (p=0.732).

Conclusions: Lower volume centers treat relatively more emergency cases than higher volume centers in transfemoral TAVI in Germany, but higher volume centers provide significantly better results both in terms of in-hospital mortality and complication rates as well as resource utilization parameters.


Figure: Continuous impact of TAVI procedure volumes with emergency admission in Germany in 2018. Predicted outcome (black line) and 95% confidence intervals (grey lines).


https://dgk.org/kongress_programme/ht2021/P96.htm