Clin Res Cardiol (2021)
DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Use and Outcomes of Emergency Treatment Strategies in Patients with Aortic Valve Stenosis
S. Piepenburg1, K. Kaier2, C. Olivier3, W. Bothe4, T. Heidt3, D. Wolf3, M. Zehender3, C. Bode3, C. von zur Mühlen5, P. Stachon3
1Innere Medizin III, Kardiologie und Angiologie, Universitätsklinikum Freiburg, Freiburg im Breisgau; 2Med. Fakultät der Universität Freiburg, Institut für Biometrie und med. Informatik, Freiburg; 3Klinik für Kardiologie und Angiologie I, Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH, Freiburg im Breisgau; 4Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg - Bad Krozingen GmbH, Freiburg im Breisgau; 5Innere Medizin III, Kardiologie und Angiologie, Albert- Ludwigs-Universität Freiburg, Freiburg im Breisgau;

Objectives 
This study aimed to evaluate the emergency treatment of patients with severe aortic valve stenosis in Germany.

Methods

Three emergency treatments of aortic valve stenosis were compared: Surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) and balloon valvuloplasty (BV). Using German nationwide records we identified 8,651 emergency patients with severe aortic valve stenosis between 2014 and 2018. Patients were grouped in SAVR, TAVR, or BV only. Primary outcome was in-hospital mortality. Stepwise multivariable logistic regression analyses were performed to assess outcome risks. 

Results

From 2014 until 2018, the annual number of emergency TAVR procedures (1,294 to 1,827, p=0.014) and BV only procedures (170 to 233, p=0.054) increased, but emergency SAVR procedures decreased (426 to 316, p=0.009). In comparison to BV only patients (mean age 81.3; mean EuroSCORE 23.2) SAVR patients were younger and at lower operative risk, as assessed by logistic EuroSCORE (mean age 66.9; mean EuroSCORE 9.4).  Patients treated with TAVR, however, were at comparable age and operative risk (mean age 81.3; mean EuroSCORE 24.4) as those patients treated with BV only. After risk adjustment, substantial differences were found for in-hospital mortality and reimbursement. In comparison to BV only, SAVR (OR 0.26 [96%CI 0.16;0.45], p<0.001) and TAVR (OR 0.38 [0.29;0.49], p<0.001) were associated with a substantially lower risk for in-hospital mortality. At the same time, the procedure-related increases in reimbursement were moderate. Compared to BV only, hospitalization costs of patients undergoing SAVR were reduced by €5,578 ([95%CI €8,023;€3,133], p<0.001), despite the resource-intensive surgical procedure. TAVR procedures were associated with higher hospitalization costs (€4,143 [€2,330;€5,926], p<0.001).

Conclusions 
BV only was associated with a substantially increased risk of in-hospital mortality. Emergency TAVR procedures are increasing with similar outcome risks compared to SAVR and therefore promising for inoperable patients.

 

Figure 1:

 
https://dgk.org/kongress_programme/jt2021/aP1599.html