Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany

Oettinger, Vera; Kaier, Klaus; Heidt, Timo; Hortmann, Markus; Wolf, Dennis; Zirlik, Andreas; Zehender, Manfred; Bode, Christoph; Mühlen, Constantin von zur; Stachon, Peter

doi:10.1136/heartjnl-2019-316058

Cited by 15 publications

(16 citation statements)

References 25 publications

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“…The study has certain strengths and limitations, in accordance with previous analyzes [ 19 – 24 ]. A major strength is the use of a very large, complete national data set of all STEMI based on electronic health records, allowing us to draw conclusions with high applicability.…”

Section: Discussionsupporting

confidence: 54%

COVID-19 pandemic affects STEMI numbers and in-hospital mortality: results of a nationwide analysis in Germany

et al. 2022

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Background The COVID-19 pandemic led to extensive restrictions in Germany in 2020, including the postponement of elective interventions. We examined the impact on ST-elevation myocardial infarction (STEMI) as an acute and non-postponable disease. Methods Using German national records, all STEMI between 2017 and 2020 were identified. Using the number of STEMI cases between 2017 and 2019, we created a forecast for 2020 and compared it with the observed number of STEMI in 2020. Results From 2017 to 2020, 248,062 patients were treated for STEMI in Germany. Mean age was 65.21 years and 28.36% were female. When comparing forecasted and observed STEMI in 2020, a correlation can be seen: noticeable fewer STEMI were treated in those weeks respectively months with an increasing COVID-19 hospitalization rate (monthly percentage decrease in STEMI: March − 14.85%, April − 13.39%, November − 11.92%, December − 22.95%). At the same time, the crude in-hospital mortality after STEMI increased significantly at the peaks of the first and second waves (relative risk/RR of monthly in-hospital mortality: April RR = 1.11 [95% CI 1.02; 1.21], November RR = 1.13 [1.04; 1.24], December RR = 1.16 [1.06; 1.27]). Conclusion The COVID-19 pandemic led to a noticeable decrease in the number of STEMI interventions in Germany at the peaks of the first and second waves in 2020, corresponding to an increase in COVID-19 hospitalizations. At the same time, in-hospital mortality after STEMI increased significantly in these phases. Graphical abstract Impact of the COVID-19 pandemic on STEMI numbers and in-hospital mortality in Germany. Relative difference between forecasted and observed STEMI numbers (above figure), the relative risk of in-hospital mortality (middle figure) as well as number of new hospital admissions for COVID-19 per million inhabitants according to Roser et al.27 (bottom figure).

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Section: Discussionsupporting

confidence: 54%

COVID-19 pandemic affects STEMI numbers and in-hospital mortality: results of a nationwide analysis in Germany

et al. 2022

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“…Therefore, our results indicate that patients treated with SAVR in very low volume centers were of comparable risk for in-hospital outcomes, which is in contrast to the volume-outcome relationships described in the literature for TAVI. 1,[16][17][18][19] This difference could be due to the fact that SAVR is a standard surgical operation and an integral part of surgical training with decades of experience. In contrast, TAVI is usually only offered at specialized centers.…”

Section: Discussionmentioning

confidence: 99%

“…There are certain limitations beyond those typical of retrospective studies, in accordance with previous analyses. 1,16 First, in administrative data coding errors are almost unavoidable. However, approximately 20% of DRG are reviewed by independent physician teams from health insurances, so overall reliability should be good.…”

Section: Limitationsmentioning

confidence: 99%

Impact of Procedure Volume on the Outcomes of Surgical Aortic Valve Replacement

Oettinger

Kaier

Mühlen

et al. 2022

Thorac Cardiovasc Surg

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Background Literature demonstrated that procedure volumes affect outcomes of patients undergoing transcatheter aortic valve implantation. We evaluated the outcomes of surgical aortic valve replacement. Methods All isolated surgical aortic valve replacement procedures in Germany in 2017 were identified. Hospitals were divided into five groups from ≤25 (very low volume) until >100 (very high volume) annual procedures. Results In 2017, 5,533 patients underwent isolated surgical aortic valve replacement. All groups were of comparable risk (logistic EuroSCORE, 5.12–4.80%) and age (66.6–68.1 years). In-hospital mortality and complication rates were lowest in the very high-volume group. Multivariable logistic regression analyses showed no significant volume–outcome relationship for in-hospital mortality, stroke, postoperative delirium, and mechanical ventilation > 48 hours. Regarding acute kidney injury, patients in the very high-volume group were at lower risk than those in the very low volume group (odds ratio [OR] = 0.53, p = 0.04). Risk factors for in-hospital mortality were previous cardiac surgery (OR = 5.75, p < 0.001), high-grade renal disease (glomerular filtration rate < 15 mL/min, OR = 5.61, p = 0.002), surgery in emergency cases (OR = 2.71, p = 0.002), and higher grade heart failure (NYHA [New York Heart Association] III/IV; OR = 1.80, p = 0.02). Risk factors for all four complication rates were atrial fibrillation and diabetes mellitus. Conclusion Patients treated in very low volume centers (≤25 operations/year) had a similar risk regarding in-hospital mortality and most complications compared with very high-volume centers (>100 operations/year). Only in the case of acute kidney injury, very high-volume centers showed better outcomes than very low volume centers. Therefore, surgical aortic valve replacement can be performed safely independent of case volume.

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“…Hospitals without a department of cardiac surgery or low volume are not allowed to perform TAVR in Germany. In these smaller hospitals, BV only may be used as a rescue therapy [ 19 20 ]. However, even if some patients are referred for definitive replacement the mortality after BV only is still high.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, some BV only may be performed for palliative indications or in emergencies, where a TAVR or SAVR is not possible due to anatomic reasons or availability of TAVR or SAVR e.g. in certain smaller hospitals [ 19 20 ]. Emergency situations in particular make it difficult to decide on one of the three different treatments.…”

Section: Introductionmentioning

confidence: 99%

Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis

et al. 2021

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Background: This study aimed to evaluate the acute treatment of patients with severe aortic valve stenosis in Germany. Methods and Results: Three treatment strategies in 11,027 patients acutely admitted due to aortic valve stenosis were compared from 2014 until 2018 using German nationwide records: The annual number of transcatheter aortic valve replacement (TAVR) procedures (1,294 to 1,827) and balloon valvuloplasty (BV only) procedures (170 to 233) in patients acutely admitted increased, but surgical aortic valve replacement (SAVR) procedures decreased (426 to 316). In comparison to BV only patients (mean age 81.3; EuroSCORE 23.2) SAVR patients were younger and at lower logistic EuroSCORE (mean age 66.9; EuroSCORE 9.4). Patients treated with TAVR were at comparable age and operative risk (mean age 81.3; EuroSCORE 24.4) as those patients treated with BV only. Primary outcome was in-hospital mortality. Reimbursement was considered secondary outcome. After risk adjustment using multivariable logistic and linear regression analyses, 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 lower risk for mortality compared to BV only. Compared to BV only, hospitalization costs of patients undergoing SAVR were reduced by €5,578 ([95%CI €8,023; €3,133], p < 0.001). TAVR procedures were associated with higher hospitalization costs than BV only (risk-adjusted difference €4,143 [€2,330; €5,926], p < 0.001). Conclusions: BV only was associated with a substantially increased risk of in-hospital mortality in acute patients. We conclude that a definitive aortic valve replacement should be preferred as primary treatment in patients with severe aortic valve stenosis causing an acute admission.

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Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany

Cited by 15 publications

References 25 publications

COVID-19 pandemic affects STEMI numbers and in-hospital mortality: results of a nationwide analysis in Germany

COVID-19 pandemic affects STEMI numbers and in-hospital mortality: results of a nationwide analysis in Germany

Impact of Procedure Volume on the Outcomes of Surgical Aortic Valve Replacement

Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis

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