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P15 Transcatheter versus Surgical Aortic Valve Replacement: A Real-World Comparison of Clinical Outcomes Based on a German Claims Dataset

      Objectives

      This study aimed to describe clinical outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve implantation (SAVR).

      Methods

      This study consisted of a retrospective analysis of German health insurance claims data from 01/01/2013-30/06/2019. Continuously insured adults with either TAVI (OPS 5-35a.0) or SAVR (OPS 5-351.0) between 01/01/2014 and 30/06/2018, who had aortic valve stenosis (ICD-10 I35.0, I35.2) were included. Patients with previous TAVI or SAVR were excluded. Both cohorts were described with regards to their baseline characteristics (one-year baseline) and the incidence rate (IR) of events during the follow-up period for death, transient ischemic attack (TIA), stroke, major bleeding event, periprocedural complications, and myocardial infarction (MI).

      Results

      Overall, 2,932 TAVI and 826 SAVR patients were identified. Compared to SAVR patients, TAVI patients were on average older (81.75 years vs. 69.18 years), more often female (56.92% vs. 42.37%), more comorbid (CCI 5.86 vs. 3.82; CHA2DS2-VASc-Score 3.17 vs. 2.47), and they had a higher probability of previous TIAs (3.07% vs. 1.33%), strokes (8.29% vs. 4.00%), and MIs (10.57% vs. 3.87%). 3.07%/1.21% of TAVI/SAVR patients died during the index hospitalization. Outcomes were observed during a follow-up period of 2.43 years (TAVI) / 3.02 years (SAVR). The following IR have been observed for TAVI/SAVR: death (0.17 vs. 0.04; p<0.001), TIA (0.00 vs. 0.01, p=0.046), stroke (0.03 vs. 0.01, p<0.001), major bleeding event (0.08 vs. 0.04, p<0.001), periprocedural complications during index hospital stay (1.87 vs. 1.13, p<0.001), and MIs (0.02 vs. 0.00; p<0.01).

      Conclusions

      TAVI has become the new standard of care in recent years and has replaced the classic aortic valve replacement, specifically in more fragile patients. The above results confirm that TAVI procedures are widely used in clinical practice, and that in line with current guidelines, physicians assess which patients should receive a TAVI or a SAVR procedure.