Transcatheter aortic valve implantation (TAVI) in Germany 2008-2014: on its way to standard therapy for aortic valve stenosis in the elderly?

Abstract

Aims: In Germany, all transcatheter aortic valve implantations (TAVI) and surgical aortic valve replacements (sAVR) are registered within an obligatory quality assurance programme led by the independent AQUA Institute. We have summarised patient and procedural characteristics, complication and mortality rates as reported in the annual, German language AQUA quality reports, freely accessible online, in order to provide a comprehensive overview of developments between 2008 and 2014.

Methods and results: Since 2008, a total of 71,927 isolated sAVR and 48,353 TAVI procedures have been performed in Germany. The numbers of sAVR are steadily declining (2008: 11,205; 2014: 9,953). For TAVI, there has been a 20-fold increase since 2008, from 637 to 13,264 procedures in 2014, surpassing the annual numbers of isolated sAVR since 2013. The age profile of TAVI patients has remained unchanged over time (mean age: 80.9 years), with a recent trend towards lower-risk/intermediate-risk patients. TAVI complications are rapidly decreasing (2012: 9.4%; 2014: 3.9%); annular rupture, aortic dissection and coronary occlusions are rare (<0.3%), with fewer patients requiring surgical conversion to sternotomy (2012: 1.2%; 2014: 0.6%). In-hospital mortality after TAVI has halved in 2014 (4.2%) compared with 2008 (10.4%).

Conclusions: Real-world clinical data from the obligatory quality assurance programme document the rapid adoption of TAVI in Germany, shifting treatment of aortic valve stenosis in the elderly from surgery to a catheter-based approach. Since 2008, similar to what happened with PCIs, complications of TAVI have declined considerably along with the need for emergency cardiac surgery. Most importantly, in-hospital mortality has halved from 2008 to 2014, while mortality for sAVR has remained unchanged.