Abstract 937 Risk adjusted analysis of transfemoral (TfAVI) and surgical (SAVR) aortic valve replacement

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Risk adjusted analysis of transfemoral (TfAVI) and surgical (SAVR) aortic valve replacement
J. E. Hannig¹, A. El-Armouche², K. Bestehorn¹
¹Institut für klinische Pharmakologie, Medizinische Fakultät Carl Gustav Carus der TU Dresden, Dresden; ²Institut für Pharmakologie und Toxikologie, Medizinische Fakultät Carl Gustav Carus der TU Dresden, Dresden;
Introduction: In recent years the TfAVI has not only developed into an alternative to SAVR for patients with severe aortic stenosis, but also surpassed it in terms of frequency. Due to very different patient collectives, it is difficult to compare the outcome of these two types of intervention. We carried out a risk-adjusted comparison on a complete dataset. Data: The 2018 dataset of the German Federal Council, containing information about all aortic valve replacements for Germany,held by the German Institute for Quality Assurance and Transparency in Healthcare (IQTIG), was analyzed. Methods: First all patients with TfAVI and SAVR replacement were compared for all available variables by descriptive statistics. Secondly all patient-clusters with exactly the same risk-/condition vectorwere identified by an exact 1:1-Matching and compared using multivariate analysis. The adjustment was based on mortality-risk variables deriving from the German Aortic valve score. The further statistical evaluation was carried out with 𝛘²-tests.In-hospital mortality (IHM) was defined as primary endpoint. Results: Out of the total patient cohort of 19371 TfAVI and 8369 SAVR procedures (mean age 81.1 years (TfAVI) / 66.9 Years (SAVR), 50.2 % / 35.6 % females) 2462 pairs with identical profile of all available factors could be identified and showed the following profile: age 76.3 years, 42.8 % females, NYHA IV 1.9 %, LVEF<31% 2.4 %, atrial fibrillation / rhythm disorders 16.7 %, arterial vascular disease 18.5 %, lung disease 15.1 %.IHM of TfAVI patients was significantly lower compared to SAVR patients (TfAVI: 1.2 % vs. SAVR: 2.2 %; p=0.006; α=0.05). The observed mortality was higher than expected for SAVR patients (O/E: 1.21) and lower than expected for TfAVI patients (O/E: 0.91). Table 1 shows the statistically significant different intra- and post-procedural complications. The procedure duration was 167.9 ± 51.4 minutes for SAVR and 62.9 ± 32.5 minutes for TfAVI (p < 0.001), post-procedural length of stay was 12.0 ± 7.7 days for SAVR vs 7.6 ± 5.4 days for TfAVI (p < 0.001). 77.5 % of patients after TfAVI could be discharged regularly vs 43.1 % after SAVR (p < 0.001). Conclusion: The analysis of a large-scale database shows that in a risk-adjusted comparison TfAVI is associated with lower in-hospital mortality than SAVR. Since only cerebrovascular events occured significantly more frequently in SAVR, their influence on mortality should be further investigated.
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