The current state of TAVI in Germany – a nationwide assessment
D Grundmann, W Kim, M Abdel Wahab, M Adam, C Frerker, O Husser, D Leistner, H Moellmann, M Saad, T Schmitz, J M Sinning, A Wolf, A Ghanem, T Rudolph, M SeiffertAbstract
Background
The recent 2025 ESC guidelines for the management of valvular heart disease emphasize the role of transcatheter aortic valve implantation (TAVI) for the treatment of severe aortic stenosis. Despite extensive scientific evidence for TAVI, many steps of the procedure or periprocedural management ultimately remain at the discretion of the operator due to a paucity of recommendations.
Aims
To assess the routine procedural and periprocedural management of patients undergoing TAVI for the treatment of aortic stenosis in Germany.
Methods
The working group for interventional cardiology (AGIK) of the German Cardiac Society (DGK) designed an online survey that was distributed to all German TAVI centers to obtain a representative assessment of clinical practice. The questionnaire comprised a total of 68 questions covering pre-procedural planning, procedural strategies, the post-procedural course and structural aspects. Data were collected from October 2023 to June 2024.
Results
The survey was completed by 56/85 centers (66%), representing a cumulative volume of approximately 20.000 procedures annually. Most centers (70%) performed 200-600 TAVI procedures per year. Preprocedural workup and procedural aspects differed: Coronary angiography remained routine in 76% of centers while transesophageal echocardiography was restricted to specific indications (86%). Analgosedation was the preferred anesthesia strategy (56%) followed by local anesthesia (24%). Transfemoral access was first-choice (93.4%), transaxillary (2.9%) and transapical (2.7%) approaches were selectively employed. US-guided puncture was performed in 54% of cases with subsequent suture-based preclosure (67%). The preferred secondary access was femoral (57%). Cerebral embolic protection (<5% in 87% of centers), and direct LV-pacing (9%) were limited to selected cases. Transcatheter heart valve selection was related to various factors, including calcification patterns (66%), annular dimensions (59%) and preservation of coronary access (51%). Final aortography (93%) and invasive hemodynamic assessment (71%) were considered standard by most respondents. Heparin was antagonized after conclusion of the procedure in most centers partially (42%) or completely (32%). Only 16% regularly transferred patients after uneventful TAVI to ICU the remainder to intermediate care or normal wards. Routine rhythm monitoring was performed for 1-2 days in 60% of centers. Aspirin was the standard antithrombotic drug after TAVI (93%) and DOAC monotherapy was preferred in patients with an indication for anticoagulation.
Conclusions
With the recent guideline-supported expansion of TAVI, this nationwide survey offers important insights into the current clinical routine and detailed (peri-)procedural steps of TAVI. These findings suggest a heterogenous approach to TAVI and may stimulate further discussions on workflow optimization to improve outcomes for patients with severe aortic stenosis.