https://doi.org/10.1007/s00392-025-02625-4
1Herzzentrum der Universität zu Köln Klinik für Kardiologie, Angiologie, Pneumologie und Internistische Intensivmedizin Köln, Deutschland; 2Herzzentrum Leipzig - Universität Leipzig Klinik für Innere Medizin/Kardiologie Leipzig, Deutschland; 3Universitätsklinikum Bonn Medizinische Klinik und Poliklinik II Bonn, Deutschland; 4Universitätsklinikum Schleswig-Holstein Innere Medizin III mit den Schwerpunkten Kardiologie, Angiologie und internistische Intensivmedizin Kiel, Deutschland; 5Universitäres Herz- und Gefäßzentrum Hamburg Allgemeine und Interventionelle Kardiologie Hamburg, Deutschland; 6Kerckhoff Klinik GmbH Bad Nauheim, Deutschland; 7Herz- und Diabeteszentrum NRW Allgemeine und Interventionelle Kardiologie/Angiologie Bad Oeynhausen, Deutschland
Background: Transcatheter aortic valve implantation (TAVI) has become the preferred treatment for severe aortic stenosis in patients 75 and older, significantly improving patient outcomes. More inclusive and lenient European guideline recommendations from 2021 may have changed the selection and outcome of TAVI patients.
Objective: To evaluate the temporal trends in patient baseline characteristics, risk profiles, and outcomes associated with TAVI from 2013 to 2023.
Methods: At 7 high-volume centers in Germany, baseline characteristics, perioperative risk and VARC-3 outcomes between 2013 to 2023 were analyzed for 33079 patients.
Results: This study analyzed 33079 patients who underwent TAVI from 2013 to 2023. The annual TAVI volume increased from 1605 in 2013 to 4459 in 2023, with a stable mean age of 81 years (Fig. 1A,B). Patients aged ≥80 years represented approximately 63% of the cohort, with significant growth in both younger (<75 years: 217 to 664, P<0.001) and older populations (≥80 years: 996 to 2,889, P<0.001). The mean Society of Thoracic Surgeons (STS) score steadily decreased from 2013 to 2021, subsequently reaching a plateau (2013 5.9±6.2%, 2023 4.1±4.3%; P<0.001) (Fig. 1C). The proportion of low-risk patients (<4% STS) increased from 47% to 66.4% (P<0.001) across all age groups (Fig. 1D). The absolute count of TAVI procedures increased especially in younger, low risk patients between 2013 (n=146) until 2023 (n=580) (P<0.001). A decrease in comorbidities was observed and female representation declined from 52.8% to 45.3% (P<0.001). Periprocedural complications including cumulative VARC-3 bleeding (2013 24.1%; 2023 8.1%; P<0.001), overall vascular complications (2013 17.2%; 2023 4.9%; P<0.001), new CIED implantation (2013 15.5%; 2023 11.4%, P<0.001) and stroke (2013 4.2%; 2023 2.1%, P<0.009) decreased significantly. Similarly, the 30-day mortality decreased from 7.1% to 2.5% (P<0.001), especially in patients > 80 years and those at intermediate surgical risk (STS 4-8% 2013 10%; 2023 2.3%; P<0.001).
Conclusion: Perioperative Risk, mortality and complication rates associated with TAVI procedures significantly decreased from 2013 to 2023. In this large multicenter registry, elderly patients over 80 years at low to intermediate surgical risk continue to drive the increasing trend of TAVI procedures in Germany.
Figure 1: Temporal trends in A: mean patient age; B: age distribution; C: predicted surgical risk (STS Score); and D: risk categories based on the STS Score.