Percutaneous and surgical management of aortic stenosis in the SWEDEHEART registry (2013-2023): a nationwide observational study.
| Title: | Percutaneous and surgical management of aortic stenosis in the SWEDEHEART registry (2013-2023): a nationwide observational study. |
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| Authors: | Tödt J; Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.; Department of Cardiology, Skåne University Hospital, Lund, Sweden.; Koul S; Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.; Department of Cardiology, Skåne University Hospital, Lund, Sweden.; Yndigegn T; Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.; Department of Cardiology, Skåne University Hospital, Lund, Sweden.; Angerås O; Department of Thoracic Surgery and Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.; Bjursten H; Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Lund University/Skåne University Hospital, Lund, Sweden.; Nozohoor S; Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Lund University/Skåne University Hospital, Lund, Sweden.; Friberg Ö; School of Medica Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.; Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.; Backes J; Department of Cardiothoracic Surgery, Anesthesia and Intensive Care, Lund University/Skåne University Hospital, Lund, Sweden.; Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.; James S; Department of Medical Sciences, Uppsala University, Uppsala, Sweden.; Redfors B; Department of Thoracic Surgery and Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.; Gilje P; Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.; Department of Cardiology, Skåne University Hospital, Lund, Sweden.; Labaf A; Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.; Department of Cardiology, Skåne University Hospital, Lund, Sweden.; Hagström H; Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.; Rück A; Division of Cardiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.; Götberg M; Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.; Department of Cardiology, Skåne University Hospital, Lund, Sweden.; Mohammad MA; Division of Cardiology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.; Department of Cardiology, Skåne University Hospital, Lund, Sweden. |
| Source: | The Lancet regional health. Europe [Lancet Reg Health Eur] 2025 Nov 03; Vol. 60, pp. 101520. Date of Electronic Publication: 2025 Nov 03 (Print Publication: 2026). |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: [Oxford] Country of Publication: England NLM ID: 101777707 Publication Model: eCollection Cited Medium: Internet ISSN: 2666-7762 (Electronic) Linking ISSN: 26667762 NLM ISO Abbreviation: Lancet Reg Health Eur Subsets: PubMed not MEDLINE |
| Imprint Name(s): | Original Publication: [Oxford] : Elsevier Ltd., [2020]- |
| Abstract: | Background: Management of severe aortic stenosis (AS) has evolved over the past decade, driven by the widespread adoption of transcatheter aortic valve implantation (TAVI). This study aims to assess trends in procedural volumes, patient characteristics, and outcomes for patients undergoing TAVI or surgical aortic valve replacement (SAVR) in Sweden.; Methods: This was a descriptive, non-comparative, nationwide cohort study using the SWEDEHEART registry. We included 21,383 patients who underwent TAVI or SAVR between 2013 and 2023 (11,366 TAVI and 10,017 SAVR). Trends in patient characteristics, preoperative risk, complications and mortality were examined.; Findings: TAVI procedures increased from 307 (26.1%, n = 307/1174) in 2013 to 1851 (71.2%, n = 1851/2601) in 2023, while SAVR volumes declined from ∼1000 annually before 2018 to roughly 750 procedures annually. Median age of TAVI patients were 81 (IQR 77, 85) years and 71 (IQR 65, 76) years for SAVR patients. The median EuroSCORE II for TAVI decreased from 5.6 (IQR 3.3, 10.2) to 2.7 (IQR 1.7, 4.6) (p = 0.002), and STS-PROM from 3.3 (IQR 1.9, 4.1) to 1.6 (IQR 1.1, 2.8) (p = 0.0021). Among SAVR patients, EuroSCORE II decreased from 1.5 (IQR 1.0, 2.3) to 1.3 (IQR 0.9, 2.1) (p = 0.022) and STS-PROM from 1.8 (IQR 1.2, 3.0) to 1.6 (IQR 1.1, 2.6) (p = 0.0082). Any in-hospital complications declined significantly for TAVI (29.2%, n = 210/719 to 13.2%, n = 244/1851), while SAVR complication rates increased slightly (18.4%, n = 354/1921 to 18.7%, n = 140/750). In-hospital mortality for TAVI declined from 3.6% (n = 26/719) to 1.0% (n = 18/1851), and 1-year mortality from 11.1% to 6.9% (p = 0.019). SAVR in-hospital all-cause death decreased from 1.6% to 0.4% (n = 3/750) and 5.0% to 2.2% for 1-year mortality (p = 0.013).; Interpretation: TAVI has become the predominant treatment strategy for AS in Sweden expanding access within the treated cohort. Despite this, current 2023 SAVR results demonstrate similar in-hospital complication rates compared to TAVI (18.7% vs 13.2%), but lower in-hospital (0.4% vs 1.0%) and 1-year mortality rates (2.2% vs 6.9%).; Funding: This study was supported by ALF and national research funding bodies.; (© 2025 The Author(s).) |
| Competing Interests: | All authors have completed the ICMJE disclosure form. AR reports consulting for Boston Scientific, Edwards Lifesciences, Anteris and research support from Boston Scientific. All other authors declare no competing interests or financial relationships with any organisations that might have an interest in the submitted work. No authors have other relationships or activities that could appear to have influenced the submitted work. |
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| Contributed Indexing: | Keywords: Aortic stenosis; Aortic valve implantation; Prosthetic aortic valve implantation; SCSR; SWEDEHEART; SWENTRY; Surgical aortic valve replacement (SAVR); Temporal trends; Transcatheter aortic valve implantation (TAVI); Valve replacement outcomes |
| Entry Date(s): | Date Created: 20251124 Date Completed: 20251124 Latest Revision: 20251126 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC12630323 |
| DOI: | 10.1016/j.lanepe.2025.101520 |
| PMID: | 41280556 |
| Database: | MEDLINE |
Journal Article