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GARY: Guideline adherence benefited patients treated with TAVI
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Data from the German Aortic Valve Registry have indicated a low in-hospital mortality rate among patients treated with transcatheter aortic valve implantation, which researchers attributed to guideline adherence.
Two German medical societies started the German Aortic Valve Registry (GARY) in July 2010 due to the growing number of TAVI procedures performed in recent years. To create a complete picture of current and future practice trends and treatment strategies, researchers looked at data collected through the registry, which included voluntarily participating German centers (92 of 99 centers).
By July 2012, more than 26,000 patients were included, of whom 23% were patients undergoing TAVI. Data presented from a first report of outcomes include 15,252 patients treated in 2011 from 53 centers.
Results presented at a press conference at the ESC Congress 2012 in Munich showed that participating centers generally adhered to current guidelines for patient selection. Study results indicated that 85% of all patients undergoing TAVI were aged older than 75 years and had a higher calculated perioperative risk for mortality.
The mean age of patients who received isolated elective and urgent conventional aortic valve replacement was 68.3 ± 11.3 years, with a logistic EuroSCORE of 8.8 ± 9.7%. Patients undergoing TAVI were on average significantly older (transfemoral, 81 ± 6.1 years; transapical, 80.3 ± 6.1 years) and had a higher operative risk.
Overall, in-hospital mortality for elective patients was 2.1% for conventional surgery, 4.5% for surgical aortic valve replacement with CABG, 5.1% for the transfemoral TAVI and 7.7% for transapical TAVI. The rate of cerebrovascular events during hospital stay was 2.2% in the surgery group, 3.7% in the transfemoral TAVI group and 3.5% in the transapical TAVI group. The rate of vascular complications was 11.9% for the transfemoral approach, 2.5% for the transapical approach and 1% for the conventional surgery group.
From these registry data, trial investigator Friedrich Mohr, MD, PhD, clinical director of the Leipzig Heart Center, Germany, concluded at the press conference that outcomes with the TAVI procedure, when used in patients at high risk, compared very well with outcomes of conventional surgery and surgery with CABG previously reported in registry and PARTNER trial data.
“Patients in high-risk groups benefit at least as much from TAVI procedures as from conventional surgery, particularly when performed transfemorally,” Mohr said in a press release.
For more information:
Mohr FW. Hot Line II: Late breaking trials on interventions. Presented at: the European Society of Cardiology Congress; Aug. 25-29, 2012; Munich.