PMID- 30897991
OWN - NLM
STAT- MEDLINE
DCOM- 20200706
LR  - 20210109
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 8
IP  - 7
DP  - 2019 Apr 2
TI  - Risk-Adjusted Comparison of In-Hospital Outcomes of Transcatheter and Surgical 
      Aortic Valve Replacement.
PG  - e011504
LID - 10.1161/JAHA.118.011504 [doi]
LID - e011504
AB  - Background Transfemoral transcatheter aortic valve replacement (TF-TAVR) is 
      recommended for patients suffering from aortic valve stenosis at increased 
      operative risk. Beyond that, patients with different comorbidities could benefit 
      from TF-TAVR. The present study compares real-world in-hospital outcomes of 
      surgical aortic valve replacement and TF-TAVR. Methods and Results For all 33 789 
      isolated TF-TAVR and surgical aortic valve replacement procedures performed in 
      Germany in 2014 and 2015, comorbidities and in-hospital outcomes were identified 
      by International Classification of Diseases (ICD)- and OPS (Operation and 
      procedure key)-codes. Patients undergoing TF-TAVR were older and at increased 
      estimated risk. Outcomes were risk-adjusted to allow comparison. TF-TAVR was 
      associated with a lower risk for acute kidney injuries (odds ratio [OR] 0.62, 
      P<0.001), for bleeding (OR 0.17, P<0.001), and for prolonged mechanical 
      ventilation (>48 hours, OR 0.21, P<0.001). Risk for stroke was similar (OR 1.07, 
      P=0.558). As expected, the risk for pacemaker implantations was higher after 
      TF-TAVR (OR 4.61, P<0.001). In all patients, none of the treatment strategies had 
      a clear advantage on the risk for in-hospital mortality (OR 0.83, P=0.068). 
      However, in patients aged >80 years and at high operative risk undergoing TF-TAVR 
      in-hospital mortality was lower (TF-TAVR versus surgical aortic valve replacement 
      80-84, OR 0.55; P=0.002; >/=85 years, OR 0.42, P=0.006; EuroSCORE (European System 
      for Cardiac Operative Risk Evaluation) >9: OR 0.62, P=0.001). TF-TAVR was 
      superior in patients with renal failure and in NYHA (New York Heart 
      Association)-Class III/IV. Other risk groups were not found to be factors 
      favoring a treatment strategy. Conclusions The present study indicates a 
      superiority of TF-TAVR in clinical practice for patients at increased operative 
      risk, aged >80 years, in NYHA-Class III/IV, and with renal failure.
FAU - Stachon, Peter
AU  - Stachon P
AD  - 1 University Heart Center Freiburg Department of Cardiology and Angiology I 
      Faculty of Medicine University of Freiburg Freiburg Germany.
FAU - Kaier, Klaus
AU  - Kaier K
AD  - 1 University Heart Center Freiburg Department of Cardiology and Angiology I 
      Faculty of Medicine University of Freiburg Freiburg Germany.
AD  - 2 Institute of Medical Biometry and Medical Informatics University Medical Center 
      Freiburg Faculty of Medicine University of Freiburg Freiburg Germany.
FAU - Zirlik, Andreas
AU  - Zirlik A
AD  - 1 University Heart Center Freiburg Department of Cardiology and Angiology I 
      Faculty of Medicine University of Freiburg Freiburg Germany.
AD  - 3 Department of Cardiology University Hospital Graz Austria.
FAU - Bothe, Wolfgang
AU  - Bothe W
AD  - 4 Department of Cardiac and Vascular Surgery Heart Center Freiburg Faculty of 
      Medicine University of Freiburg Freiburg Germany.
FAU - Heidt, Timo
AU  - Heidt T
AD  - 1 University Heart Center Freiburg Department of Cardiology and Angiology I 
      Faculty of Medicine University of Freiburg Freiburg Germany.
FAU - Zehender, Manfred
AU  - Zehender M
AD  - 1 University Heart Center Freiburg Department of Cardiology and Angiology I 
      Faculty of Medicine University of Freiburg Freiburg Germany.
FAU - Bode, Christoph
AU  - Bode C
AD  - 1 University Heart Center Freiburg Department of Cardiology and Angiology I 
      Faculty of Medicine University of Freiburg Freiburg Germany.
FAU - von Zur Muhlen, Constantin
AU  - von Zur Muhlen C
AD  - 1 University Heart Center Freiburg Department of Cardiology and Angiology I 
      Faculty of Medicine University of Freiburg Freiburg Germany.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
SB  - IM
MH  - Acute Kidney Injury/*epidemiology
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/*surgery
MH  - Cardiac Pacing, Artificial/statistics & numerical data
MH  - Female
MH  - Germany/epidemiology
MH  - Heart Valve Prosthesis Implantation
MH  - *Hospital Mortality
MH  - Humans
MH  - Length of Stay/statistics & numerical data
MH  - Male
MH  - Middle Aged
MH  - Pacemaker, Artificial
MH  - Postoperative Complications/epidemiology
MH  - Postoperative Hemorrhage/*epidemiology
MH  - Respiration, Artificial/statistics & numerical data
MH  - Stroke/*epidemiology
MH  - *Transcatheter Aortic Valve Replacement
PMC - PMC6509703
OTO - NOTNLM
OT  - aortic stenosis
OT  - aortic valve
OT  - surgery
OT  - transcatheter aortic valve
OT  - transcatheter aortic valve implantation
EDAT- 2019/03/23 06:00
MHDA- 2020/07/07 06:00
PMCR- 2019/04/02
CRDT- 2019/03/23 06:00
PHST- 2019/03/23 06:00 [entrez]
PHST- 2019/03/23 06:00 [pubmed]
PHST- 2020/07/07 06:00 [medline]
PHST- 2019/04/02 00:00 [pmc-release]
AID - JAH33954 [pii]
AID - 10.1161/JAHA.118.011504 [doi]
PST - ppublish
SO  - J Am Heart Assoc. 2019 Apr 2;8(7):e011504. doi: 10.1161/JAHA.118.011504.