Thorac cardiovasc Surg 2014; 62(08): 639-644
DOI: 10.1055/s-0034-1395972
Others
Georg Thieme Verlag KG Stuttgart · New York

Kommentar der Deutschen Gesellschaft für Thorax-, Herz- und Gefäßchirurgie zum Positionspapier der DGK - Qualitätskriterien zur Durchführung der transvaskulären Aortenklappenimplantation (TAVI)

Jochen Cremer
1  Klinik für Herz- und Gefäßchirurgie, UK Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Markus K. Heinemann
2  Klinik und Poliklinik für Herz, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Mainz, Germany
,
Friedrich Wilhelm Mohr
3  Klinik für Herzchirurgie, Herzzentrum Leipzig GmbH, Leipzig, Germany
,
Anno Diegeler
4  Abteilung für Kardiochirurgie, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany
,
Friedhelm Beyersdorf
5  Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany
,
Heidi Niehaus
1  Klinik für Herz- und Gefäßchirurgie, UK Schleswig-Holstein, Campus Kiel, Kiel, Germany
,
Stephan Ensminger
6  Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
,
Christian Schlensak
7  Klinik für THG-Chirurgie, Universitätsklinikum Tübingen, Tübingen, Germany
,
Hermann Reichenspurner
8  Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg UKE, Hamburg, Germany
,
Ardawan Rastan
9  Klinik für Herz- und Gefäßchirurgie, HKZ GmbH & Co. Betriebs KG, Rotenburg a.d.Fulda, Germany
,
Georg Trummer
5  Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany
,
Thomas Walther
10  Herzzentrum, Klinik für Herzchirurgie, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
,
Rüdiger Lange
11  Deutsches Herzzentrum München des Freistaates Bayern, Klinik für Herz- und Gefäßchirurgie, München, Germany
,
Volkmar Falk
12  Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
,
Andreas Beckmann
13  Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie [DGTHG], Langenbeck-Virchow-Haus, Berlin, Germany
,
Armin Welz
14  Klinik für Herzchirurgie, Universitätsklinikum Bonn, Bonn, Germany
› Author Affiliations
Further Information

Publication History

28 October 2014

28 October 2014

Publication Date:
21 November 2014 (eFirst)

Abstract

Surgical aortic valve replacement is still considered the first-line treatment for patients suffering from severe aortic valve stenosis. In recent years, transcatheter aortic valve implantation (TAVI) has emerged as an alternative for selected high-risk patients. According to the latest results of the German external quality assurance program, mandatory by law, the initially very high mortality and procedural morbidity have now decreased to approximately 6 and 12%, respectively. Especially in Germany, the number of patients treated by TAVI has increased exponentially. In 2013, a total of 10.602 TAVI procedures were performed. TAVI is claimed to be minimally invasive. This is true concerning the access, but it does not describe the genuine complexity of the procedure, defined by the close neighborhood of the aortic valve to delicate intracardiac structures. Hence, significant numbers of life-threatening complications may occur and have been reported. Owing to the complexity of TAVI, there is a unanimous concordance between cardiologists and cardiac surgeons in the Western world demanding a close heart team approach for patient selection, intervention, handling of complications, and pre- as well as postprocedural care, respectively. The prerequisite is that TAVI should not be performed in centers with no cardiac surgery on site. This is emphasized in all international joint guidelines and expert consensus statements. Today, a small number of patients undergo TAVI procedures in German hospitals without a department of cardiac surgery on site. To be noted, most of these hospitals perform less than 20 cases per year. Recently, the German Cardiac Society (DGK) published a position paper supporting this practice pattern. Contrary to this statement and concerned about the safety of patients treated this way, the German Society for Thoracic and Cardiovascular Surgery (DGTHG) still fully endorses the European (ESC/EACTS) and other actual international guidelines and consensus statements. Only the concomitance of departments for cardiac surgery and cardiology on site can provide optimal TAVI care. This commentary by the DGTHG delineates the data and resources upon which its opinion is based.