Aims The MY-3F [Fit & Fun with Football after myocardial infarction (MI) or coronary artery disease (CAD)] study was the first to investigate whether a structured and health-adapted football training programme can improve fitness and risk factors in patients with CAD and whether it is safe. The primary objective of this study was to improve fitness in maximum oxygen uptake in spiroergometry (VO2peak), blood pressure, weight, and safety. Methods and results The MY-3F study is a prospective randomized interventional study with 1-year follow-up in patients with MI or CAD. A football group (FG, n = 89) completed a structured ‘health’ football training (1 h/week, 75 min) led by licensed football coaches. The results were compared with a control group (CG, n = 88). VO2peak in the FG significantly increased from 18.0 to 19.7 mL/min/kg (P < 0.001), and VO2peak in the CG significantly decreased from 19.5 to 18.3 mL/min/kg (P = 0.046). In the FG, running performance per participant per training improved from 1.8 km at admission to 2.4 km at the end of study (P < 0.001). In the FG, blood pressure decreased from 132/81 to 125/76 mmHg (P < 0.001). In the CG, it changed slightly from 137/82 to 136/82 mmHg (ns). In addition, a significantly more antihypertensives were given in CG, but not in FB. In the FG, weight decreased from 92.3 to 90.4 kg (P = 0.003). In the CG, it increased slightly from 90.7 to 91 kg (P = 0.6 ns). Depressive symptoms showed a significant improvement in the FG (P = 0.034), but no changes were observed in the CG. There was no significant change in LDL cholesterol in both groups, but significantly more lipid-lowering therapy was administered in the CG (P = 0.049). Conclusion In My-3F, the preventive benefit on CVRF (cardiovascular risk factors) and fitness of football training in patients after MI or CAD was clearly demonstrated for the first time. The concept proved to be safe and cost-effective and could open the doors of football clubs to evidence-based cardiological prevention.

Cardiovascular disease is the leading cause of death worldwide, and among survivors of heart failure, peripheral arterial disease, valvular disease, and atrial fibrillation many develop motor impairment: weakness, slow gait, sarcopenia, frailty. These deficits are usually attributed to deconditioning or coexisting conditions. This narrative review advances a different hypothesis: that reduced arterial blood delivery, from a failing pump or a narrowed artery, itself drives motor impairment at every level of the motor pathway, from cortex to muscle fibre. We group cardiovascular conditions into systemic models of low blood flow (heart failure with reduced or preserved ejection fraction, low-flow aortic stenosis, atrial fibrillation) and regional models of arterial obstruction (carotid, subclavian, and vertebral stenosis; peripheral arterial disease), quantifying the perfusion deficit where haemodynamic data exist. We then examine mechanisms: cerebral hypoperfusion that thins the motor cortex and weakens motor planning; vulnerability of the cerebellum, basal ganglia, and spinal motor neurons, impairing coordination and gait; ischaemic peripheral nerve damage that denervates muscle; loss of muscle capillaries, mitochondrial injury, and failed regeneration; amplified feedback from underperfused muscle that suppresses central motor drive; and gating of corticospinal excitability by the cardiac cycle. Causality is supported by within-patient comparisons, in which a lateralised ischaemic limb or hypoperfused hemisphere weakens while the opposite side, under identical systemic conditions, does not; by graded perfusion-to-outcome relationships; and by recovery after cardiac transplantation, ventricular assist device support, valve replacement, and revascularisation. Deconditioning amplifies these effects rather than causing them, so treatment should restore blood flow and rebuild muscle together.

Lipoprotein(a) [Lp(a)] is a known independent risk factor for cardiovascular disease, yet awareness and management remain limited. The psychosocial implications of elevated Lp(a)-levels have been poorly characterized. To compare cardiovascular outcomes and cardiovascular risk factor (CVRF) modification in individuals with normal vs. elevated Lp(a) levels, and to assess the impact of individualized prevention recommendations. For the first time, the individual psychological stress caused by Lp(a) is being surveyed. The ELITE study is a prospective, interventional cohort study conducted in north-western Germany. Participants were regularly assessed for CVRFs, including Lp(a), hypertension, dyslipidemia, diabetes mellitus, weight, nicotine – as well as lipoprotein (a), physical activity, dietary habits, depression and stress. They received written, personalized prevention recommendations. Follow-up averaged 4.4 years. Two groups were analyzed: Group 1 (Gr1, n=3,241) with normal Lp(a), and Group 2 (Gr2, n=841) with elevated Lp(a ≥75 nmol/l). Gr2 (mean Lp(a) 154.8 nmol/l) and Gr1 (mean Lp(a) 16.4 nmol/l) were comparable in age ( 53 years) and sex distribution ( 49

Herz-Kreislauf-Erkrankungen sind voraussichtlich bis 2050 die Krankheitsbilder mit der höchsten Morbidität und Mortalität und stellen die Versorger vor neue Herausforderungen. Auf diesem Hintergrund wird der teilstationären Versorgung eine zunehmende Bedeutung zukommen. Die Mitglieder der Ordinarienkonferenz Kardiologie e. V. haben sich 2023 und 2024 in Arbeitstreffen mit der zukünftigen Ausrichtung von universitären Kliniken für Kardiologie befasst. Hierauf aufbauend wurde ein Konsensuspapier verfasst, das die strategischen Eckpfeiler, Spezifika und Herausforderungen der universitären Kardiologie zusammenfasst und sich an die Vorstände der Universitätsklinika, den Verband der Universitätsklinika Deutschlands e. V. (VUD), den Gemeinsamen Bundesausschuss (G-BA), Kostenträger und die Entscheidungsträger der Ministerien für Gesundheit, Wissenschaft und Finanzen der jeweiligen Bundesländer sowie im Bund richtet. Die Inhalte dieses Konsensuspapiers werden im vorliegenden Beitrag skizziert.

This prospective cohort study examines the association between hyperuricemia (HU) and cardiovascular diseases. We analyzed data from 4,082 participants, dividing them into two groups based on serum uric acid levels. Our findings reveal that participants with elevated serum uric acid or xanthine oxidase inhibitor (XOI) therapy had a significantly higher incidence of cardiovascular events such as coronary artery disease (8.4% vs 3.3%), stroke (2.6% vs. 1.2%), heart failure (3.4% vs. 0.9%), and chronic kidney insufficiency (4.5% vs. 1.9%) compared to those with normal uric acid levels. Moreover, group 2, which had higher serum uric acid levels, also exhibited a higher burden of established cardiovascular risk factors, including hypertension, obesity, and diabetes. These results support the hypothesis that HU is not only a marker for metabolic dysfunction but may also serve as an independent risk factor for cardiovascular morbidity and mortality. We propose that routine measurement of uric acid levels could be a valuable tool for early identification of high-risk cardiovascular patients, particularly in individuals with multiple metabolic risk factors. Further prospective studies are needed to explore the potential benefits of early XOI therapy in reducing cardiovascular events.

Educational attainment might impact secondary prevention after myocardial infarction (MI). The purpose of the present study was to compare the rate of risk factors and the efficacy of an intensive prevention program (IPP), performed by prevention assistants and supervised by physicians, in patients with MI and different levels of education. In this post hoc analysis of the multicenter IPP and NET-IPP trials, patients with MI were stratified into two groups according to educational attainment: no “Abitur” (no A) vs. “Abitur” or university degree (AUD). The groups were compared at the time of index MI and after 12-month IPP vs. usual care. Out of n = 462 patients with MI, 76.0

Seit der Veröffentlichung der ESC/ESH-Leitlinien zur arteriellen Hypertonie im Jahr 2018 wurden mehrere scheinkontrollierte, qualitativ hochwertige Studien zur renalen Denervation veröffentlicht, die die Sicherheit und Effektivität der renalen Denervation belegen. Die renale Denervation stellt daher aktuell eine additive Therapieoption bei Patienten mit unkontrollierter therapieresistenter Hypertonie dar, wobei Letztere mittels Langzeitblutdruckmessung bestätigt werden sollte. Die renale Denervation könnte zudem auch bei ausgewählten Patienten mit Unverträglichkeiten gegen Antihypertensiva zur Anwendung kommen. Bei der Entscheidungsfindung sollten nach ausführlicher Aufklärung die Präferenz der Patienten sowie deren individuelles kardiovaskuläres Risiko berücksichtigt werden. Ein multidisziplinäres Hypertonieteam sollte die Indikation zur renalen Denervation stellen und die Behandlung durchführen. Die Interventionalisten müssen Erfahrung bei der Durchführung renaler Interventionen besitzen und ein spezifisches Training für die renale Denervation erhalten. Die renale Denervation sollte in Deutschland in spezialisierten Zentren erfolgen, die von den Fachgesellschaften festgelegte personelle, räumliche und apparative Qualitätskriterien erfüllen, welche in einem eigenen Konsensusdokument veröffentlich wurden [23].

We report a case of a large thrombus entrapped in a patent foramen ovale after bariatric surgery and pulmonary embolism. The 60-year-old female patient was admitted to hospital as an emergency after syncope. She suffered from metabolic syndrome with obesity (height: 180 cm, weight: 170 kg, BMI: 49.4 kg/m 2 ) and an insulin-dependent diabetes mellitus type 2. She had had bariatric surgery (implantation of a gastric balloon) 4 weeks prior to hospitalization. A transthoracic echocardiography was performed which indicated a large entrapped thrombus in the patent foramen ovale with extensions of approximately 10 cm in both the right and the left heart. Surgical embolectomy was performed to remove the circa 20-cm-long thrombus.At the time of surgery, only 2 cm of the transit thrombus remained in the right atrium. Thus, during the time between diagnosis and emergency surgery, the thrombus had gradually migrated 8 cm. Pulmonary embolectomy and closure of the patent foramen ovale were performed during the same procedure. The patient recovered completely without any complications and was discharged 11 postoperatively. This case demonstrates the importance of urgent medical decision-making with transit thrombi — time is running out.

Zusammenfassung Hintergrund Die COVID-19-Pandemie und deren Maßnahmen haben zu einem Defizit der medizinischen Versorgung und zu Änderungen in der Lebensführung der Menschen geführt, was in der Konsequenz auch die kardio- und zerebrovaskuläre Primär- und Sekundärprävention verändert hat. Die vorhandenen Daten beruhen im Wesentlichen auf Umfragen. Neben der Problematik der Korrektheit von Selbsteinschätzungen können die Pandemie per se und die massive öffentliche Berichterstattung die Daten verzerrt haben. Nur wenige Publikationen haben vor der Pandemie erhobene Daten mit den Ergebnissen im Verlauf der Pandemie verglichen. In der ELITE-Studie werden seit Jahren bei über 5000 Teilnehmern regelmäßige Kontrollen von Risikofaktoren (RF) und psychosozialen Parametern (Stress, Depressionen, Wohlbefinden, Ernährung, Hirnleistung, Bewegung) vorgenommen. Aus dieser Studie wurden die Daten von 1775 Personen ausgewertet, die vor Beginn und erneut während der Pandemie (06.05.2020–25.01.2022) erhoben wurden. Damit waren die Ausgangswerte unbeeinflusst von der Pandemie. Ergebnisse Erwartungsgemäß fanden sich sowohl Verbesserungen als auch Verschlechterungen der erhobenen Parameter. Blutdruck und depressive Symptome verschlechterten sich signifikant häufiger, wobei Frauen häufiger betroffen waren. Auch das Gewicht und die Stressbelastung stiegen häufiger an, als dass sie sich verbesserten. Nur die körperliche Aktivität zeigte eine geringgradige Zunahme. 24,1 % wiesen ausschließlich Verschlechterungen und keine Verbesserungen dieser Parameter auf. Demgegenüber zeigten 19,6 % ausschließlich Verbesserungen. In der Gruppe mit ausschließlich Verschlechterungen fand sich ein signifikanter Anstieg von Personen mit den Risikofaktoren (RF) Hypertonie, Adipositas, erhöhtes LDL-Cholesterin, Nikotin und Diabetes mellitus. Dies führte zu einer Zunahme von Personen mit 2 und mehr RF. Dagegen reduzierte sich die Zahl von Personen mit 2 und mehr RF in der Gruppe, die nur Verbesserungen aufwies. Auffällig war, dass sich Personen mit Risikofaktoren häufiger verbesserten. Folgerung Bei einem nicht unerheblichen Teil der Bevölkerung kam es in der Pandemie zu deutlichen Verschlechterungen der RF. Dies betraf besonders den Blutdruck und depressive Symptome – und dabei häufiger Frauen.

Cardiovascular diseases continue to be the most imminent health care problems in the western world, accounting for numerous deaths per year. Heart failure (HF), namely the reduction of left ventricular function, is one of the major cardiovascular disease entities. It is chronically progressing with relapsing acute decompensations and an overall grave prognosis that is little different if not worse than most malignant diseases. Interestingly acute metabolically and/or immunologically challenging events like infections or major surgical procedures will cause relapses in the course of preexisting chronic heart failure, decrease the patients wellbeing and worsen myocardial function. HF itself and or its progression has been demonstrated to be driven at least in part by inflammatory pathways that are similarly turned on by infectious or non-infectious stress responses. These thus add to HF progression or relapse. TNF-α plasma levels are associated with disease severity and progression in HF. In addition, several cytokines (e.g., IL-1β, IL-6) are involved in deteriorating left ventricular function. Those observations are based on clinical studies using inhibitors of cytokines or their receptors or they stem from animal studies examining the effect of cytokine mediated inflammation on myocardial remodeling in models of heart failure. This short review summarizes the known underlying immunological processes that are shared by and drive all: chronic heart failure, select infectious diseases, and inflammatory stress responses. In conclusion the text provides a brief summary of the current development in immunomodulatory therapies for HF and their overlap with treatments of other disease entities.

Mitral and tricuspid regurgitation are highly prevalent types of valvular heart disease, important drivers of a poor prognosis and subject to catheter-based treatment. The transcatheter reconstruction of the valves has meanwhile evolved as an important alternative to pure medicinal treatment and surgical interventions. Whereas transcatheter treatment of tricuspid valve insufficiency has recently shown effectiveness and safety in the first registries, transcatheter treatment of mitral valve insufficiency has meanwhile been tested in several randomized trials. This paper comments on the results of these trials and presents recommendations regarding the indications for the interventional treatment modalities available for mitral and tricuspid valve regurgitation. As part of this manuscript and in an effort to further improve the quality of care, the German Cardiac Society has updated the criteria for the certification of centers for transcatheter treatment of mitral valve insufficiency.

Based on the results of several recent randomized trials, European and American guidelines on valvular heart disease management have substantially expanded the indications for transcatheter aortic valve implantation (TAVI). We present an all-comer data on peri-operative risk profile and in-hospital outcomes from Germany for patients treated by TAVI or isolated surgical aortic valve replacement (iSAVR) in 2020, providing an opportunity to compare study data with data from daily clinical practice. Data concerning all isolated aortic valve procedures performed in Germany in 2020 were retrieved from the mandatory nationwide quality control program. Expected mortality was calculated with the annually revised German Aortic valve score (AKL-score) based on the data of either catheter-based (AKL-CATH) or isolated surgical (AKL-CHIR) aortic valve replacement in Germany from the previous year (2019). In 2020 21,903 TAVI procedures (20,810 transvascular (TV; vs. 2019: 22.973; − 9.4%), 1093 transapical (TA; vs. 2019: 1413; − 22.6%)) and 6144 (vs. 2019 7905; − 22.5%) iSAVR were performed in Germany. Patients who received TAVI showed a significantly higher perioperative risk profile than patients undergoing iSAVR based on older age and more severe co-morbidities. While in-hospital mortality after TAVI (2.3%) was numerically lower than in 2019 (2.5%), this difference was not significant (p = 0.11). In-hospital mortality after iSAVR was identical in 2020 and 2019 (2.8%) and thus higher than after TAVI (p = 0.003), resulting in an observed expected mortality ratio of 1.02 after TAVI and 1.05 after iSAVR. After exclusion of the emergency procedures, in-hospital mortality did not differ significantly between the groups (TAVI 2.2% vs. iSAVR 1.9%, p = 0.26). Total numbers of both iSAVR and TAVI in Germany were lower in 2020 than in 2019, most likely due to the COVID-19 pandemic. However, the relative number of patients treated by TAVI as compared to iSAVR continues to increase. Despite older age and more severe comorbidities compared to patients undergoing iSAVR the in-hospital mortality after TAVI continued to decrease in 2020 and remains significantly lower than after iSAVR.

In der Legende der Abb. 1 des Originalbeitrags wurde die Abkürzung „TMVR“ falsch aufgelöst. Richtig muss es heißen: „TMVR kathetergestützte Mitralklappenrekonstruktion“. Nachfolgend finden Sie die Abbildung mit der korrekten Legende. Wir bitten, diesen Fehler zu entschuldigen und die korrigierte …

Lipoprotein(a) (Lp(a)) is becoming increasingly important as an independent risk factor for cardiovascular disease. Since no effective therapy currently exists other than lipid apheresis, the recommendation remains to optimally adjust all other cardiovascular risk factors (CVRF). In a Northwest German population study, the frequency of elevated Lp(a) levels and all other CVRF was investigated. The aim was to investigate whether individuals with elevated Lp(a) levels were also more likely to have other CVR Fs. To date, 4602 individuals have been enrolled in the study, and blood pressure, weight, lipids, diabetes, medications, and pre-existing conditions were recorded in addition to Lp(a). In addition, questionnaires assessed physical activity, psychological stress, depression, and brain dysfunction. All participants received detailed individual recommendation about their CVRF and its treatment. In the further follow-up of 5 years, it will be examined how persons with elevated Lp(a) implemented these recommendations in comparison with participants without elevated Lp(a). The first group Lp(a) <75 nmol/L consisted of 3550 (80.2%), the Lp(a) 75 120 nmol/L group of 341 (7.4%) and the Lp(a) >120 nmol/L of 538 (11.7%). 81 .6% of all participants hadoneor more CVRF. Age, sex, and prevalence of hypertension, diabetes, smoking, obesity, and exercise did not differ among the 3 groups. As expected, LDL-Cholesterol was significantly elevated in the Lp(a) >120 nmol/L group despite significantly more frequent use of statins. Significantly moreoften hypertensive patients werefound in the Lp(a) >120 nmol/L group who were inadequately controlled by medication and significantly less often persons without further CVRF. No differences existed in the frequency of psychological stress, depression, and mild cognitive impairment. CVRF occur with comparable frequency in individuals with elevated Lp(a) levels. However, individuals with Lp(a) above 120 nmol/L were more likely to have poorly controlled blood pressure, elevated LDL-C, and less likely to have no other risk factors. This underlines that in case of Lp(a) elevation all further CVRF should be intensively adjusted, especially in case of strongly elevated values >120 nmol/L. However, these recommendations have not been adequately implemented in clinical care in this population to date.

Dieses Manual zur interventionellen Therapie (Teil 2) ist eine Anwendungsempfehlung für interventionell tätige Ärzte, die den gegenwärtigen Kenntnisstand unter Berücksichtigung neuester Studienergebnisse wiedergibt. Hierzu wurde in den einzelnen Kapiteln speziell auf die Alltagstauglichkeit der Empfehlungen geachtet, sodass dieses Manual jedem interventionell tätigen Kardiologen als Entscheidungshilfe im Herzkatheterlabor dienen soll. Trotz der von vielen Experten eingebrachten praktischen Hinweise kann dieses Manual dennoch nicht die ärztliche Evaluation des individuellen Patienten ersetzen und damit eine Anpassung der Diagnostik bzw. Therapie ersetzen.

Die arterielle Hypertonie gehört in den westlichen Industrienationen durch ihre hohe Prävalenz zu den häufigsten chronischen Erkrankungen und ist ein Hauptrisikofaktor für kardiovaskuläre Morbidität und Mortalität. In der Pathophysiologie der unkontrollierten Hypertonie kommt der Überaktivität des sympathischen Nervensystems eine wichtige Bedeutung zu. Seit einigen Jahren steht mit der renalen Denervation (RDN) ein katheterbasiertes Verfahren zur selektiven renalen Sympathektomie zur Verfügung. In mehreren randomisierten, durch Scheinprozedur kontrollierten Studien konnte die Wirksamkeit und Sicherheit des Verfahrens bestätigt werden, sodass davon auszugehen ist, dass die RDN auch klinisch zum Einsatz kommen wird. Ziel der Zertifizierung der Renalen-Denervations-Zentren ist es, einen national verbindlichen Mindeststandard für Zentren zur Durchführung der RDN zu definieren sowie über eine Netzwerkbildung die Betreuung der Patienten mit unkontrollierter Hypertonie zu optimieren. Institutionen, welche die RDN durchführen, wird im Zuge eines Evaluationsverfahrens die Möglichkeit gegeben, entsprechend zertifiziert zu werden.

Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are established options to treat aortic valve stenosis. We present the outcome of the complete cohort of all patients undergoing SAVR or TAVI in Germany during the calendar year 2019. Data concerning all isolated aortic valve procedures performed in Germany in 2019 were retrieved from the mandatory nationwide quality control program: 22,973 transvascular (TV)-TAVI procedures, 7905 isolated SAVR (iSAVR), and 1413 transapical (TA)-TAVI. Data was complete in 99.9% (n = 32,156). In-hospital mortality after TV-TAVI (2.3%) was significantly lower when compared with iSAVR (2.8%, p = 0.007) or TA-TAVI (6.3%; p < 0.001). Expected mortality was calculated with a new version of the German Aortic valve score (AKL Score) based on the data of either catheter-based (AKL-CATH) or surgical (AKL-CHIR) aortic valve replacements in Germany in 2018. TV-TAVI and iSAVR both showed lower observed mortality in 2019 than expected based on their respective performance in 2018, yielding an observed/expected (O/E) mortality ratio < 1. This was particularly apparent for patients at low risk. After exclusion of emergency procedures, in-hospital mortality after TV-TAVI (2.1%) and after iSAVR (2.1%) was identical, even though patients undergoing TV-TAVI showed a considerably higher perioperative risk profile. After excluding emergency procedures, in-hospital mortality of TV-TAVI and iSAVR in 2019 in Germany was identical. In 2019, TV-TAVI and iSAVR both show lower matched mortality ratios compared with 2018, which suggests technical improvements of both therapies.

Effective long-term prevention after myocardial infarction (MI) is crucial to reduce recurrent events. In this study the effects of a 12-months intensive prevention program (IPP), based on repetitive contacts between non-physician "prevention assistants" and patients, were evaluated. Patients after MI were randomly assigned to the IPP versus usual care (UC). Effects of IPP on risk factor control, clinical events and costs were investigated after 24 months. In a substudy efficacy of short reinterventions after more than 24 months ("Prevention Boosts") was analyzed. IPP was associated with a significantly better risk factor control compared to UC after 24 months and a trend towards less serious clinical events (12.5% vs 20.9%, log-rank p = 0.06). Economic analyses revealed that already after 24 months cost savings due to event reduction outweighted the costs of the prevention program (costs per patient 1,070 euro in IPP vs 1,170 (sic) in UC). Short reinterventions ("Prevention Boosts") more than 24 months after MI further improved risk factor control, such as LDL cholesterol and blood pressure lowering. In conclusion, IPP was associated with numerous beneficial effects on risk factor control, clinical events and costs. The study thereby demonstrates the efficacy of preventive long-term concepts after MI, based on repetitive contacts between non-physician coworkers and patients. (C) 2021 Elsevier Inc. All rights reserved.

Transcatheter aortic valve implantation (TAVI) is emerging as the standard of care for patients with severe aortic stenosis. Recent results have been favourable even for patients with low periprocedural risk. We analysed the number of procedures, complications, and in-hospital mortality rates of all patients undergoing isolated aortic valve replacement in 2017 in Germany, focussing especially on transvascular (TV) TAVI. Patients were stratified according the German Aortic Valve Score (AKL) into the risk classes low, intermediate, high and very high (≥ 10%). A total of 17,956 TV-TAVI and 9011 isolated surgical aortic valve replacements (iSAVR) were performed in Germany in 2017. Although the total rate of intraprocedural complications after TV-TAVI was the same as in 2016 (both 7.4%), fewer patients experienced an arterial vascular complication in 2017 (2017: 6.0%; 2016: 7.1%; p < 0.001). Likewise, the rate of new pacemaker implantation decreased (2017: 9.6%; 2016:11.4%; p < 0.001). In-hospital mortality after TV-TAVI and iSAVR was equal (2.7%) in 2017, despite the much higher risk profile of TV-TAVI patients. Using the AKL score as reference, TV-TAVI showed a more favourable observed-to-expected mortality (O/E) ratio (0.89) than iSAVR (1.14)- even more pronounced in patients at low risk (0.81 vs. 1.14). The rates of major complications like bleeding and permanent pacemaker implantation after TV-TAVI keep declining. In 2017 patients undergoing TV-TAVI had a low in-hospital mortality rate with an O/E ratio < 1, indicating that the results were again better than those of all TAVI and SAVR of the previous year. Overall in-hospital mortality after transvascular TAVI and isolated aortic valve repair 2017 in Germany stratified to risk groups by the German Aortic Valve Score (German AV Score/AKL Score): low risk group (AKL 0– < 3%), intermediate risk group (AKL 3– < 6%), high risk group (AKL 6– < 10%) and very high risk group (AKL ≥ 10%)