Prognostic impact of patient age on in-hospital mortality and complications after surgical and percutaneous pulmonary valve implantation in Germany: a nation-wide cohort study
S Grundmann, J Hummel, K Kaier, P Stachon, A Asmussen, D Westermann, B StillerAbstract
Aim
The aim of the current study was to elucidate predictors of in-hospital complications and mortality in all patients undergoing surgical pulmonary valve replacement (SPVR) or percutaneous pulmonary valve implantation (PPVI) n Germany in a complete nationwide dataset from 2007 until 2018.
Methods and Results
Diagnoses, procedures, and in-hospital outcome data coded for reimbursement purposes were provided by the Research Data Centers of the Federal Bureau of Statistics of Germany since 2007, when reimbursement for PPVI became available in Germany. In total, 5,809 surgical pulmonary valve replacement procedures and 1,608 PPVI were performed in Germany between 2007 and 2018. The annual number of PPVI increased from 16 to 190 in 2018, whereas surgical replacement procedures remained relatively constant during the studied time period. Numbers of percutaneous procedures peaked in patients aged 13 to 14 years, whereas numbers of treated patients beyond 35 years of age were low. In the SPVR cohort most of the procedures were performed in patients below 20 years of age without a distinct age peak. Indication for surgical treatment was predominantly pulmonary valve regurgitation, whereas in the endovascular treatment group stenosis and regurgitation were recorded with equal frequency. In-hospital mortality was significantly correlated with increasing age, as were other adverse events. Throughout all age groups, mortality was significantly lower after endovascular treatment than after surgical procedures (0.87% vs. 2.88%; p<0.001).
Conclusion
Increasing age was a significant risk factor for death and in-hospital complications after surgical pulmonary valve replacement and percutaneous pulmonary valve implantation, with the highest risk in the elderly. Patients with PPVI showed a lower mortality and short-term complication rate. However, the clinical setting and underlying pathology differed between the two treatment groups, making surgical and percutaneous pulmonary valve implantation complementary treatment options with an overall low complication rate, especially for the growing number of adult patients with congenital heart disease.