Evaluation of risk score for isolated surgical aortic valve replacement and transcatheter aortic valve replacement—results from the German national quality database

Abstract OBJECTIVES For the treatment of aortic valve stenoses, both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are available. We compared the frequently used Euroscore with the AKL-Cath- and the AKL-Chir Score, describing the mortality risk of the two different treatment methods. METHODS Based on a retrospective cohort study using mandatory quality assurance data, we analysed the frequency and the outcomes (primary end-point: in-hospital mortality) of all patients treated in Germany between 2015 and 2020. The observed results were compared to the predicted risk using the Euroscore, the AKL-Cath Score and the AKL-Chir Score. RESULTS Our data show a reduction in the number of isolated SAVR procedures from 9,790 in 2015 to 6,106 in 2020, corresponding to a 37.6% decrease. Over the same period, the number of TAVI procedures increased from 15,653 to 21,501, an increase of 37.3%. Regarding in-hospital mortality following TAVI, there was a decline from 4% (2015) to 2.5% (2020), while in-hospital mortality following SAVR remained nearly constant at 3%. Over the study period, there is an overestimation of TAVI risk while simultaneously underestimating SAVR risk by EuroSCORE II. In contrast, the mortality risk of patients is well estimated using the AKL-Kath Score in the TAVI group and the AKL-Chir Score in the SAVR group. The AKL-Chir Score in TAVI patients overestimates their mortality, while the AKL-Kath Score underestimates the mortality of SAVR patients. CONCLUSIONS AKL Chir score and AKL Cath score estimate the mortality risk of SAVR and TAVI patients more precisely than the Euroscore II.