Treatment of pure aortic regurgitation using surgical or transcatheter aortic valve replacement between 2018 and 2020 in Germany

Abstract

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.

Transcatheter aortic valve implantation versus surgical aortic valve replacement for pure aortic regurgitation: a systematic review and meta-analysis of 33,484 patients

“…The decreased risk of postoperative stroke to half the incidence after SAVR is a very interesting finding of this meta-analysis, which suggests the superiority of TAVI in AR patients. Our results align with previous reports [ 21 , 31 ].…”

“…The mortality rates between TAVI and SAVR were comparable. This finding aligns with previous research and supports the notion that TAVI is not inferior to SAVR regarding overall patient survival in AR [ 18 , 19 , 31 ] and also AS patients [ 33 – 35 ]. In our cohort, TAVI patients were older and had higher comorbidity scores, which aligns with the current recommendations and practice directions that TAVR is assigned only to patients with higher risk who cannot undergo surgery [ 3 , 5 ].…”

“…Only 115 titles were eligible for full-text screening following the title and abstract screening. Finally, six studies were included [ 18 – 21 , 31 , 32 ] with a total of 5633 patients for TAVI and 27,851 patients for SAVR (PRISMA flow diagram; Fig. 1 ).…”

“…Although our study had a shorter follow-up period (in-hospital) compared to previous single-arm meta-analysis studies, we believe that the mortality rate after TAVI is decreasing due to the growing experience of the operators. The most recent studies report a mortality rate after TAVI of 3.7 and 2.01% among patients treated between 2018 and 2020 and 2016–2019, respectively [ 21 , 31 ]. The source of heterogeneity in our analysis was Stachon et al 2020 [ 20 ]; after excluding it, the overall RR favored the TAVI over SAVR (RR = 0.72; 95% CI: [0.59, 0.89], P = 0.003).…”