Aims: Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established options to treat aortic valve stenosis. We present the outcome of the complete cohort of all patients undergoing SAVR or TAVI in Germany during the calendar year 2019.

Methods: Data concerning all isolated aortic valve procedures performed in Germany in 2019 were retrieved from the mandatory nationwide quality control program.
Expected mortality was calculated with a new version of the German Aortic valve score (AKL Score) based on the data of either catheter-based (AKL-CATH) or surgical (AKL-CHIR) aortic valve replacements in Germany in 2018. Using this mortality the observed/expected mortality ratio was calculated.  The patients were divided into perioperative risk groups: very high (>10%), high (6-10%), intermediate (3-<6%), and low (<3%). Calculations regarding O/E mortality were repeated in each risk group and compared to the year 2018.

Results:
In 2019 22,973 transvascular (TV)-TAVI procedures, 7,905 isolated SAVR (iSAVR), and 1,413 transapical (TA)-TAVI were performed.

Vascular complications after TV-TAVI occurred rarely (5.7% vs. 6.1% in 2018; p=0.08) and were mainly driven by bleeding (45.1%) and hematoma (49.0%). The rate of intraprocedural complications was also low 6.0% (vs. 2018: 6.2%; p=0.49). In-hospital mortality after TV-TAVI decreased continuously in recent years, even though the further decline from 2018 to 2019 was not significant (2019: 2.3% vs. 2018: 2.5%; p=0.15). The difference in in-hospital mortality was significant in the low- and very high-risk group (0-<3% 2019: 1.4% vs. 2018 1.7%, p=0.03; 3-<6% 2019: 3.8% vs. 2018: 3.7%, p=0.61; 6-<10% 2019: 7.9% vs. 2018: 6.5% p=0.30; >=10% 2019: 18.4% vs. 2018: 13.1% vs. 2017: 16.4%, p=0.02).

In-hospital mortality after TV-TAVI (2.3%) was significantly lower when compared with iSAVR (2.8%, p=0.007) or TA-TAVI (6.3%, p<0.001).
TV-TAVI and iSAVR both showed lower observed mortality in 2019 than expected based on their respective performance in 2018 (O/E TV-TAVI 0,90; iSAVR 0,90). This was particularly apparent for patients at low risk (O/E for TV-TAVI 0,82, for iSAVR 0,87).

After exclusion of emergency procedures, in-hospital mortality after TV-TAVI (2.1%) and after iSAVR (2.1%) was identical, even though patients undergoing TV-TAVI showed a considerably higher perioperative risk profile.

Conclusion: After excluding emergency procedures, in-hospital mortality of TV-TAVI and iSAVR in 2019 in Germany was identical. In 2019, TV-TAVI and iSAVR both show lower matched mortality ratios compared with 2018, which suggests technical improvements of both therapies.