Author + information
- Received May 10, 2018
- Revision received July 5, 2018
- Accepted July 10, 2018
- Published online November 5, 2018.
- Florian Egger, MDa,∗∗ (, )
- David Zweiker, MDb,∗,
- Matthias K. Freynhofer, MDa,
- Verena Löfflera,
- Miklos Rohla, MD, PhDa,c,
- Alexander Geppert, MDa,
- Serdar Farhan, MDa,d,
- Birgit Vogel, MDa,d,
- Jürgen Falkensammer, MDe,f,
- Johannes Kastner, MDg,
- Philipp Pichler, MDg,
- Paul Vock, MDh,
- Gudrun Lamm, MDh,
- Olev Luha, MDb,
- Albrecht Schmidt, MDb,
- Daniel Scherr, MDb,i,
- Matthias Hammerer, MDj,
- Uta C. Hoppe, MDj,
- Edwin Maurer, MDk,
- Michael Grund, MDl,
- Thomas Lambert, MDl,
- Wolfgang Tkalec, MDm,
- Thomas Sturmberger, MDm,
- Eduard Zeindlhofer, MDn,
- Martin Grabenwöger, MDf,o,
- Kurt Huber, MDa,f,
- for the Austrian TAVI Group
- a3rd Medical Department, Cardiology, Intensive Care Medicine and Chest Pain Unit, Wilhelminenhospital, Vienna, Austria
- bDivision of Cardiology, Department of Internal Medicine, Medical University Graz, Graz, Austria
- cInstitute for Cardiometabolic Diseases, Karl Landsteiner Society, St. Pölten, Austria
- dIcahn School of Medicine at Mount Sinai, New York, New York
- e1st Surgical Department, Vascular Surgery, Wilhelminenhospital, Vienna, Austria
- fMedical School Sigmund Freud University, Vienna, Austria
- gDepartment of Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
- hDepartment of Internal Medicine III, Karl Landsteiner University Hospital St. Pölten, St. Pölten, Austria
- iDepartment of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands
- jClinic of Internal Medicine II, Department of Cardiology, Paracelsus Medical University of Salzburg, Salzburg, Austria
- k2nd Medical Department with Cardiology and Intensive Care Unit, Hospital Wels-Grieskirchen, Wels, Austria
- lDepartment of Cardiology, Kepler University Hospital Linz, Linz, Austria
- m2nd Medical Department, Cardiology, Angiology and Intensive Care Unit, Hospital Elisabethinen, Linz, Austria
- nDepartment of Internal Medicine, Hospital Barmherzige Schwestern, Linz, Austria
- oDepartment for Cardiothoracic Surgery, Hospital Hietzing, Vienna, Austria
- ↵∗Address for correspondence:
Dr. Florian Egger, 3rd Medical Department, Cardiology, Intensive Care Medicine and Chest Pain Unit, Wilhelminenhospital Montleartstrasse 37, A-1160, Vienna, Austria.
Objectives This study sought to investigate the outcome of high-risk and inoperable patients with severe symptomatic aortic stenosis undergoing transfemoral transcatheter aortic valve replacement (TAVR) in hospitals with (iOSCS) versus without institutional on-site cardiac surgery (no-iOSCS).
Background Current guidelines recommend the use of TAVR only in institutions with a department for cardiac surgery on site.
Methods In this analysis of the prospective multicenter Austrian TAVI registry, 1,822 consecutive high-risk patients with severe symptomatic aortic stenosis undergoing transfemoral TAVR were evaluated. A total of 290 (15.9%) underwent TAVR at no-iOSCS centers (no-iOSCS group), whereas the remaining 1,532 patients (84.1%) were treated in iOSCS centers (iOSCS group).
Results Patients of the no-iOSCS group had a higher perioperative risk defined by the logistic EuroSCORE (20.9% vs. 14.2%; p < 0.001) compared with patients treated in hospitals with iOSCS. Procedural survival was 96.9% in no-iOSCS centers and 98.6% in iOSCS centers (p = 0.034), whereas 30-day survival was 93.1% versus 96.0% (p = 0.039) and 1-year survival was 80.9% versus 86.1% (p = 0.017), respectively. After propensity score matching for confounders procedural survival was 96.9% versus 98.6% (p = 0.162), 93.1% versus 93.8% (p = 0.719) at 30 days, and 80.9% versus 83.4% (p = 0.402) at 1 year.
Conclusions Patients undergoing transfemoral TAVR in hospitals without iOSCS had a significantly higher baseline risk profile. After propensity score matching short- and long-term mortality was similar between centers with and without iOSCS.
↵∗ Drs. Egger and Zweiker contributed equally to the manuscript.
Dr. Egger has received speaker honoraria from Medtronic. Dr. Rohla has received speaker and/or advisory fees from Novartis, Daiichi-Sankyo, Biotronik, and Takeda Pharma. Dr. Geppert has received speaker honoraria from Medtronic. Dr. Luha has received speaker honoraria from Medtronic, Direct Flow Medical, and St. Jude Medical/Abbott. Dr. Hammerer has received speaker honoraria from Medtronic. Dr. Hoppe has received speaker honoraria from Medtronic and Edwards. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 10, 2018.
- Revision received July 5, 2018.
- Accepted July 10, 2018.
- 2018 American College of Cardiology Foundation