German Heart Surgery Report 2021: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery

Beckmann, Andreas; Lewandowski, Jana; Markewitz, Andreas; Blaßfeld, Daniela; Böning, Andreas

doi:10.1055/s-0042-1754353

Cited by 55 publications

(51 citation statements)

References 27 publications

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“…Indeed, in the NACSA 2022 reports, the ratio of TAVR to SAVR rose from 1.2:1 to 2.3:1, which dramatically accelerated during the COVID-19 pandemic ( 23 ). The annual volume of TAVR has already exceeded SAVR in the USA and Germany ( 24 , 25 ).…”

Section: Discussionmentioning

confidence: 99%

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Chan

Dimagli

Fudulu

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveSurgical aortic valve replacement (SAVR) is traditionally the gold-standard treatment in patients with aortic valve disease. The advancement of transcatheter aortic valve replacement (TAVR) provides an alternative treatment to patients with high surgical risks and those who had previous cardiac surgery. We aim to evaluate the trend, early clinical outcomes, and the choice of prosthesis use in isolated SAVR in the United Kingdom.MethodsAll patients (n = 79,173) who underwent elective or urgent isolated surgical aortic valve replacement (SAVR) from 1996 to 2018 were extracted from the National Adult Cardiac Surgery Audit database. Patients who underwent additional procedures and emergency or salvage SAVR were excluded from the study. Trend and clinical outcomes were investigated in the whole cohort. Patients who had previous cardiac surgery, high-risk groups (EuroSCORE II >4%), and predicted/observed mortality were evaluated. Furthermore, the use of biological prostheses in five different age groups, that are <50, 50–59, 60–69, 70–79, and >80, was investigated. Clinical outcomes between the use of mechanical and biological aortic valve prostheses in patients <65 years old were analyzed.ResultsThe number of isolated SAVR increased across the study period with an average of 4,661 cases performed annually after 2010. The in-hospital/30-day mortality rate decreased from 5.28% (1996) to 1.06% (2018), despite an increasing trend in EuroSCORE II. The number of isolated SAVR performed in octogenarians increased from 596 to 2007 (the first year when TAVR was introduced in the UK) to 872 in 2015 and then progressively decreased to 681 in 2018. Biological prosthesis usage increased across all age groups, particularly in the 60–69 group, from 24.59% (1996) to 81.87% (2018). There were no differences in short-term outcomes in patients <65 years old who received biological or mechanical prostheses.ConclusionSurgical aortic valve replacement remains an effective treatment for patients with isolated aortic valve disease with a low in-hospital/30-day mortality rate. The number of patients with high-risk and octogenarians who underwent isolated SAVR and those requiring redo surgery has reduced since 2016, likely due to the advancement in TAVR. The use of biological aortic prostheses has increased significantly in recent years in all age groups.

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Section: Discussionmentioning

confidence: 99%

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Chan

Dimagli

Fudulu

et al. 2023

Front. Cardiovasc. Med.

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“…While the pioneering Rao and Cosgrove teams attempted to develop minimally invasive surgical techniques in the 1990s, minimally invasive surgery remains underappreciated and has not advanced to the accepted standard of care [ 1 , 2 , 15 , 16 ]. For example, even >10 years after Rao (1993) and Cosgrove (1996) published their techniques, only a small proportion (4.7%) of all aortic valve procedures were not performed through full sternotomy in Germany in 2007 [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of the Transaxillary Access for Minimally Invasive Aortic Valve Surgery

Wilbring¹,

Alexiou²,

Schmidt³

et al. 2023

Medicina

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Background and Objectives: Transaxillary access is one of the latest innovations for minimally invasive aortic valve replacement (MICS-AVR). This study compares clinical performance in a large transaxillary MICS-AVR group to a propensity-matched sternotomy control group. Materials and Methods: This study enrolled 908 patients undergoing isolated AVR with a mean age of 69.4 ± 18.0 years, logistic EuroSCORE of 4.0 ± 3.9%, and body mass index (BMI) of 27.3 ± 6.1 kg/m2. The treatment group comprised 454 consecutive transaxillary MICS-AVR patients. The control group was 1:1 propensity-matched out of 3115 consecutive sternotomy aortic valve surgeries. Endocarditis, redo, and combined procedures were excluded. The multivariate matching model included age, left ventricular ejection fraction, logistic EuroSCORE, pulmonary hypertension, coronary artery disease, chronic lung disease, and BMI. Results: Propensity-matching was successful with subsequent comparable clinical baselines in both groups. MICS-AVR had longer skin-to-skin time (120.0 ± 31.5 min vs. 114.2 ± 28.7 min; p < 0.001) and more frequent bleeding requiring chest reopening (5.0% vs. 2.4%; p < 0.010), but significantly less packed red blood cell transfusions (0.57 ± 1.6 vs. 0.82 ± 1.6; p = 0.040). In addition, MICS-AVR patients had fewer access site wound abnormalities (1.5% vs. 3.7%; p = 0.038), shorter intensive care unit stays (p < 0.001), shorter ventilation times (p < 0.001), and shorter hospital stays (7.0 ± 5.1 days vs. 11.1 ± 6.5; p < 0.001). No significant differences were observed in stroke > Rankin 2 (0.9% vs. 1.1%; p = 0.791), renal replacement therapy (1.5% vs. 2.4%; p = 0.4762), and hospital mortality (0.9% vs. 1.5%; p = 0.546). Conclusions: Transaxillary MICS-AVR is at least as safe as AVR by sternotomy and can be performed in the same time frame. Its advantages are fewer transfusions and quicker postoperative recovery with a significantly shorter hospital stay. The cosmetic result and unrestricted physical abilities due to the untouched sternum and ribs are unique advantages of transaxillary access.

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“…In beiden Gruppen sind die Hälfte der Patienten NYHA-Klasse 2, während eine ASA-Klassifizierung nicht angegeben ist. Damit sind die Patienten auffällig jung, schlank und scheinbar wenig beeinträchtigt, während der durchschnittliche herzchirurgische Patient in Deutschland älter, korpulenter und weniger belastbar ist [ 7 – 9 ]. Es ist Spekulation, ob ältere Patienten mit einem vermutlich niedrigeren Hb von der Hochdosistherapie mit TXA profitieren könnten, oder sich bei wahrscheinlich schon vorbestehenden Organschäden die TXA-Nebenwirkungen deutlicher ausprägen würden.…”

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Der OPTIMAL-Trial zur Tranexamsäure im herzchirurgischen OP – Hilft viel auch viel?

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2022

Anaesthesiologie

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German Heart Surgery Report 2021: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery

Cited by 55 publications

References 27 publications

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Trend and early outcomes in isolated surgical aortic valve replacement in the United Kingdom

Safety and Efficacy of the Transaxillary Access for Minimally Invasive Aortic Valve Surgery

Der OPTIMAL-Trial zur Tranexamsäure im herzchirurgischen OP – Hilft viel auch viel?

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