Study highlights evolution of TAVR, SAVR use in Germany

In patients with aortic stenosis in Germany, the use of transcatheter aortic valve replacement increased markedly from 2007 to 2013, with a moderate concomitant decrease in surgical aortic valve replacement observed during the same period.

Researchers assessed patient characteristics and in-hospital outcomes for all cases of TAVR (n = 32,581) and SAVR (n = 55,992) performed in Germany from 2007 to 2013.

In 2007, 8,622 SAVR procedures and 144 TAVR procedures were performed. The researchers noted that the first CE marks were granted in March and November 2007. A slight decline in SAVR procedures was observed thereafter, to 7,048 procedures in 2013, while a steady annual increase was observed in the number of TAVR procedures, to 9,147 in 2013.

The mean age of patients undergoing TAVR was 81 years compared with 70 years for those undergoing SAVR. TAVR patients also had higher preoperative risk (estimated logistic EuroSCORE, 22.4% vs. 6.3%).

Analysis by age revealed a minor change in the number of SAVR procedures performed in patients aged younger than 80 years and a modest decrease in procedures performed in those older than 80 years. According to the researchers, the overall rise in TAVR use was largely attributed to a marked increase in procedures performed in patients aged 80 years and older. Use of mechanical prostheses during SAVR decreased from 21% in 2007 to 12% in 2013, and use was typically restricted to patients aged younger than 75 years. Use of bioprosthetic implants did not change during the study period.

TAVR access via the transfemoral and transpical routes also increased during the study period, but more than three-quarters of all TAVR procedures in 2013 were performed via transfemoral access.

In other findings, TAVR-associated in-hospital mortality declined from 13.2% to 5.4% and SAVR-associated in-hospital mortality declined from 3.8% to 2.2%. In 2013, the rate of TAVR-associated in-hospital mortality was equal to that of SAVR in patients aged 80 to 84 years (4.4% for both), despite disparities in risk.

“The decline in in-hospital mortality in the group undergoing TAVR was probably due to a combination of factors, including a ‘learning curve’ effect on procedural skills and improvements in patient selection and care, as well as advances in device development,” the researchers wrote.

Complications including bleeding, need for pacemaker implantation and stroke decreased over time after both procedures.

“The data reveal significant trends toward improvement in outcomes for both TAVR and SAVR,” the researchers concluded. – by Jennifer Byrne

Disclosure: Two researchers report financial ties with Edwards Lifesciences and one researcher reports financial ties with DirectFlow Medical.