Abstract 28 Temporal trends of TAVI treatment characteristics in high volume centers in Germany 2013

Objective

To assess temporal trends of patient baseline characteristics, risk profile and outcome of transcatheter aortic valve implantation (TAVI) between 2013 and 2020.

Background

Guideline recommendations and increasing confidence in TAVI therapy may have changed the selection of TAVI patients.

Methods

Baseline risk profile and VARC-2 outcome of 15,344 patients undergoing TAVI at 5 high volume centers in Germany over the time period 2013 to 2020 was analyzed.

Results

Over the eight years, annual TAVI volumes more than doubled from 1071 in 2013 to 2996 in 2020. The baseline surgical risk estimated by the Society of Thoracic Surgeons (STS) score declined from 7.2±6.2% to 4.6±3.7% (P<0.001) as a consequence of lower comorbidity burden, whereas mean age remained unchanged (2013: 81.0±6.1; 2020: 80.8±6.4; P=0.976) with patients ≥80 years accounting for about two-third of the treated cohort.

Periprocedural complications including bleeding (2013: 24.5%; 2020: 12.1%; P<0.001), vascular complications (2013: 20.7%; 2020: 11.7%; P<0.001) and new permanent pacemaker implantation (2013: 20.1%; 2020: 13.8%, P<0.001) decreased significantly. Similarly, the 30-day mortality decreased from 5.4% to 2.1% (P<0.001), but remained high in high-risk patients (STS >8%: 2013: 7.5%; 2020: 6.9%; P=0.778)

Conclusion

From 2013 to 2020 mortality and burden of complications following TAVI procedure significantly decreased in a large multicenter registry from Germany. Proportion of elderly patients remained stable, while the surgical risk profile decreased. A substantial expansion to younger patients could not be observed.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Temporal trends of TAVI treatment characteristics in high volume centers in Germany 2013 – 2020
V. Mauri¹, M. Abdel-Wahab², S. Bleiziffer³, V. Veulemans⁴, A. Sedaghat⁵, M. Adam¹, G. Nickenig⁵, M. Kelm⁴, H. Thiele², S. Baldus⁶, T. K. Rudolph⁷
¹Klinik III für Innere Medizin, Herzzentrum der Universität zu Köln, Köln; ²Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; ³Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen; ⁴Klinik für Kardiologie, Pneumologie und Angiologie, Universitätsklinikum Düsseldorf, Düsseldorf; ⁵Medizinische Klinik und Poliklinik II, Universitätsklinikum Bonn, Bonn; ⁶Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin, Herzzentrum der Universität zu Köln, Köln; ⁷Klinik für Kardiologie, Herz- und Diabeteszentrum NRW, Bad Oeynhausen;
Objective To assess temporal trends of patient baseline characteristics, risk profile and outcome of transcatheter aortic valve implantation (TAVI) between 2013 and 2020. Background Guideline recommendations and increasing confidence in TAVI therapy may have changed the selection of TAVI patients. Methods Baseline risk profile and VARC-2 outcome of 15,344 patients undergoing TAVI at 5 high volume centers in Germany over the time period 2013 to 2020 was analyzed. Results Over the eight years, annual TAVI volumes more than doubled from 1071 in 2013 to 2996 in 2020. The baseline surgical risk estimated by the Society of Thoracic Surgeons (STS) score declined from 7.2±6.2% to 4.6±3.7% (P<0.001) as a consequence of lower comorbidity burden, whereas mean age remained unchanged (2013: 81.0±6.1; 2020: 80.8±6.4; P=0.976) with patients ≥80 years accounting for about two-third of the treated cohort. Periprocedural complications including bleeding (2013: 24.5%; 2020: 12.1%; P<0.001), vascular complications (2013: 20.7%; 2020: 11.7%; P<0.001) and new permanent pacemaker implantation (2013: 20.1%; 2020: 13.8%, P<0.001) decreased significantly. Similarly, the 30-day mortality decreased from 5.4% to 2.1% (P<0.001), but remained high in high-risk patients (STS >8%: 2013: 7.5%; 2020: 6.9%; P=0.778) Conclusion From 2013 to 2020 mortality and burden of complications following TAVI procedure significantly decreased in a large multicenter registry from Germany. Proportion of elderly patients remained stable, while the surgical risk profile decreased. A substantial expansion to younger patients could not be observed.
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