Die Entwicklung und Ergebnisse von TAVI und chirurgischem Aortenklappenersatz in Deutschland 2014 bis 2015

Zusammenfassung

Einleitung Die Behandlung der Aortenklappenstenose unterliegt seit der Einführung von Transkatheterklappen (TAVI) einem großen Wandel. Die vorliegende Studie untersucht die Behandlungsrealität 2014 und 2015 in Deutschland.

Methode Es wurden alle 38 414 isolierten chirurgischen Aortenklappeneingriffe und TAVIs durch Abfrage von Behandlungscodes analysiert.

Ergebnisse Seit 2014 werden in Deutschland mehr TAVI-Prozeduren als chirurgische Aortenklappeneingriffe durchgeführt. Insgesamt kam es zu einem deutlichen Anstieg von Eingriffen an der Aortenklappe: 2009 waren es insgesamt 10 858, 2015 schon 19 929. Im Jahre 2015 wurden Patienten ab 75 Jahren bevorzugt mit transfemoraler TAVI (TF-TAVI) behandelt. Bei Patienten über 80 Jahre wurde ein chirurgischer Klappenersatz lediglich 474-mal durchgeführt (im Vergleich: TF-TAVI: 7519; transapikale (TA)-TAVI: 1192). TAVI-Patienten waren deutlich älter, häufiger weiblichen Geschlechts, hatten mehr Vorerkrankungen und ein erhöhtes Operationsrisiko. Die innerklinische Mortalität lag nach chirurgischem Aortenklappeneingriff bei 2 %, nach TF-TAVI bei 3 % und nach TA-TAVI bei 6 %. Schlaganfallraten waren zwischen den drei Verfahren vergleichbar. Blutungen traten nach chirurgischem Aortenklappeneingriff und TA-TAVI zu 9 bzw. 8 % auf, nach TF-TAVI zu 3 %. Nach TF-TAVI wurden 66 % nach Hause entlassen, nach chirurgischem Klappenersatz 40 %.

Diskussion TF-TAVI ist zwischenzeitlich bei über 75-Jährigen der bevorzugte Aortenklappenersatz. Trotz eines im Vergleich zum chirurgischen Aortenklappenersatz deutlich kränkeren Kollektivs konnten Patienten sicher mit TAVI behandelt werden.

Abstract

Introduction Treatment of aortic valve stenosis has been changing since the introduction of transcatheter aortic valve replacement (TAVR). The present study investigates the treatment of aortic valve stenosis in a real-world population 2014 and 2015 in Germany.

Methods Patient characteristics and in-hospital outcomes of all 38 414 isolated surgical aortic valve replacements (SAVR) or TAVR were analyzed.

Results Since 2014 more TAVR than SAVR were performed in Germany. Overall interventions on the aortic valve increases: from 10 858 in 2009 to 19 929 in 2015. In 2015 patients > 75 were mainly treated with transfemoral (TF) TAVR. SAVR was performed in 474 patients over 80 years (for comparison: TF-TAVR: 7519; transapical (TA) TAVR: 1192). Patients treated with TAVR were older, more often female, and had more co-morbidities. Consequently, they were at higher operative risk. Overall in-hospital mortality was 2 % after SAVR, 3 % after TF-TAVR, and 6 % after TA-TAVR. Stroke rates were similar. Relevant bleeding events occurred after SAVR and TA-TAVR in 9 % and 8 % respectively and 3 % after TF-TAVR. 66 % of patients after TF-TAVR and 40 % after SAVR were discharged home.

Discussion TF-TAVR has become the most often performed therapy for patients > 75. Despite a higher operative risk, patients can be treated safely with TF-TAVR.

Schlüsselwörter

TAVI - Aortenklappenstenose - chirurgischer Aortenklappenersatz - Mortalität - Aortenklappenprothese

Key words

TAVI - aortic valve stenosis - surgical aortic valve replacement - mortality - prosthetic aortic valve

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