Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany
BackgroundIn pure aortic regurgitation, transcatheter aortic valve replacement (TAVR) is not yet used on a regular base. Due to constant development of TAVR, it is necessary to analyze current data.MethodsBy use of health records, we analyzed all isolated TAVR or surgical aortic valve replacements (...
| Hlavní autoři: | , , , , , , , , |
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| Médium: | Článek |
| Jazyk: | English |
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Frontiers Media S.A.
2023-05-01
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| Edice: | Frontiers in Cardiovascular Medicine |
| Témata: | |
| On-line přístup: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1091983/full |
| _version_ | 1827955983922495488 |
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| author | Vera Oettinger Vera Oettinger Ingo Hilgendorf Dennis Wolf Peter Stachon Peter Stachon Adrian Heidenreich Adrian Heidenreich Manfred Zehender Manfred Zehender Dirk Westermann Klaus Kaier Klaus Kaier Constantin von zur Mühlen Constantin von zur Mühlen |
| author_facet | Vera Oettinger Vera Oettinger Ingo Hilgendorf Dennis Wolf Peter Stachon Peter Stachon Adrian Heidenreich Adrian Heidenreich Manfred Zehender Manfred Zehender Dirk Westermann Klaus Kaier Klaus Kaier Constantin von zur Mühlen Constantin von zur Mühlen |
| author_sort | Vera Oettinger |
| collection | DOAJ |
| description | BackgroundIn pure aortic regurgitation, transcatheter aortic valve replacement (TAVR) is not yet used on a regular base. Due to constant development of TAVR, it is necessary to analyze current data.MethodsBy use of health records, we analyzed all isolated TAVR or surgical aortic valve replacements (SAVR) for pure aortic regurgitation between 2018 and 2020 in Germany.Results4,861 procedures—4,025 SAVR and 836 TAVR—for aortic regurgitation were identified. Patients treated with TAVR were older, showed a higher logistic EuroSCORE, and had more pre-existing diseases. While results indicate a slightly higher unadjusted in-hospital mortality for transapical TAVR (6.00%) vs. SAVR (5.71%), transfemoral TAVR showed better outcomes, with self-expanding compared to balloon-expandable transfemoral TAVR having significantly lower in-hospital mortality (2.41% vs. 5.17%; p = 0.039). After risk adjustment, balloon-expandable as well as self-expanding transfemoral TAVR were associated with a significantly lower mortality vs. SAVR (balloon-expandable: risk adjusted OR = 0.50 [95% CI 0.27; 0.94], p = 0.031; self-expanding: OR = 0.20 [0.10; 0.41], p < 0.001). Furthermore, the observed in-hospital outcomes of stroke, major bleeding, delirium, and mechanical ventilation >48 h were significantly in favor of TAVR. In addition, TAVR showed a significantly shorter length of hospital stay compared to SAVR (transapical: risk adjusted Coefficient = −4.75d [−7.05d; −2.46d], p < 0.001; balloon-expandable: Coefficient = −6.88d [−9.06d; −4.69d], p < 0.001; self-expanding: Coefficient = −7.22 [−8.95; −5.49], p < 0.001).ConclusionsTAVR is a viable alternative to SAVR in the treatment of pure aortic regurgitation for selected patients, showing overall low in-hospital mortality and complication rates, especially with regard to self-expanding transfemoral TAVR. |
| first_indexed | 2024-04-09T14:56:28Z |
| format | Article |
| id | doaj.art-7f1eb901baca4a258fb555d480b29df8 |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-09T14:56:28Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-7f1eb901baca4a258fb555d480b29df82023-05-02T04:30:12ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-05-011010.3389/fcvm.2023.10919831091983Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in GermanyVera Oettinger0Vera Oettinger1Ingo Hilgendorf2Dennis Wolf3Peter Stachon4Peter Stachon5Adrian Heidenreich6Adrian Heidenreich7Manfred Zehender8Manfred Zehender9Dirk Westermann10Klaus Kaier11Klaus Kaier12Constantin von zur Mühlen13Constantin von zur Mühlen14Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyCenter for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyCenter for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyCenter for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyCenter for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyDepartment of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyCenter for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyInstitute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center—University of Freiburg, Freiburg, GermanyDepartment of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyCenter for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology, University Heart Center, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, GermanyBackgroundIn pure aortic regurgitation, transcatheter aortic valve replacement (TAVR) is not yet used on a regular base. Due to constant development of TAVR, it is necessary to analyze current data.MethodsBy use of health records, we analyzed all isolated TAVR or surgical aortic valve replacements (SAVR) for pure aortic regurgitation between 2018 and 2020 in Germany.Results4,861 procedures—4,025 SAVR and 836 TAVR—for aortic regurgitation were identified. Patients treated with TAVR were older, showed a higher logistic EuroSCORE, and had more pre-existing diseases. While results indicate a slightly higher unadjusted in-hospital mortality for transapical TAVR (6.00%) vs. SAVR (5.71%), transfemoral TAVR showed better outcomes, with self-expanding compared to balloon-expandable transfemoral TAVR having significantly lower in-hospital mortality (2.41% vs. 5.17%; p = 0.039). After risk adjustment, balloon-expandable as well as self-expanding transfemoral TAVR were associated with a significantly lower mortality vs. SAVR (balloon-expandable: risk adjusted OR = 0.50 [95% CI 0.27; 0.94], p = 0.031; self-expanding: OR = 0.20 [0.10; 0.41], p < 0.001). Furthermore, the observed in-hospital outcomes of stroke, major bleeding, delirium, and mechanical ventilation >48 h were significantly in favor of TAVR. In addition, TAVR showed a significantly shorter length of hospital stay compared to SAVR (transapical: risk adjusted Coefficient = −4.75d [−7.05d; −2.46d], p < 0.001; balloon-expandable: Coefficient = −6.88d [−9.06d; −4.69d], p < 0.001; self-expanding: Coefficient = −7.22 [−8.95; −5.49], p < 0.001).ConclusionsTAVR is a viable alternative to SAVR in the treatment of pure aortic regurgitation for selected patients, showing overall low in-hospital mortality and complication rates, especially with regard to self-expanding transfemoral TAVR.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1091983/fullaortic regurgitationtranscatheter aortic valve replacementtranscatheter aortic valve implantationsurgical aortic valve replacementin-hospital outcomesnational electronic health records |
| spellingShingle | Vera Oettinger Vera Oettinger Ingo Hilgendorf Dennis Wolf Peter Stachon Peter Stachon Adrian Heidenreich Adrian Heidenreich Manfred Zehender Manfred Zehender Dirk Westermann Klaus Kaier Klaus Kaier Constantin von zur Mühlen Constantin von zur Mühlen Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany Frontiers in Cardiovascular Medicine aortic regurgitation transcatheter aortic valve replacement transcatheter aortic valve implantation surgical aortic valve replacement in-hospital outcomes national electronic health records |
| title | Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany |
| title_full | Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany |
| title_fullStr | Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany |
| title_full_unstemmed | Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany |
| title_short | Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany |
| title_sort | treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in germany |
| topic | aortic regurgitation transcatheter aortic valve replacement transcatheter aortic valve implantation surgical aortic valve replacement in-hospital outcomes national electronic health records |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1091983/full |
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