Use and Outcomes of Acute Treatment Strategies in Patients with Severe Aortic Valve Stenosis
Sven M. Piepenburg,
Klaus Kaier,
Christoph B. Olivier,
Wolfgang Bothe,
Timo Heidt,
Markus Jäckel,
Alexander Peikert,
Dennis Wolf,
Manfred Zehender,
Christoph Bode,
Daniel Dürschmied,
Constantin von zur Mühlen,
Peter Stachon
Affiliations
Sven M. Piepenburg
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Klaus Kaier
Medical Center – University of Freiburg, Institute of Medical Biometry and Statistics, Freiburg; Center of Big Data Analysis in Cardiology (CeBAC), Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Christoph B. Olivier
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Wolfgang Bothe
Medical Center – University of Freiburg, University Heart Center, Department of Cardiovascular Surgery, Freiburg
Timo Heidt
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Markus Jäckel
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Alexander Peikert
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Dennis Wolf
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Manfred Zehender
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg; Center of Big Data Analysis in Cardiology (CeBAC), Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Christoph Bode
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Daniel Dürschmied
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim
Constantin von zur Mühlen
Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg; Center of Big Data Analysis in Cardiology (CeBAC), Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg
Peter Stachon
Center of Big Data Analysis in Cardiology (CeBAC), Medical Center – University of Freiburg, University Heart Center, Department of Cardiology and Angiology I, Freiburg; First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim
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.
