Thorac cardiovasc Surg 2014; 62(08): 639-644
DOI: 10.1055/s-0034-1395972
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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 Cremer1, Markus K. Heinemann2, Friedrich Wilhelm Mohr3, Anno Diegeler4, Friedhelm Beyersdorf5, Heidi Niehaus1, Stephan Ensminger6, Christian Schlensak7, Hermann Reichenspurner8, Ardawan Rastan9, Georg Trummer5, Thomas Walther10, Rüdiger Lange11, Volkmar Falk12, Andreas Beckmann13, Armin Welz14
  • 1Klinik für Herz- und Gefäßchirurgie, UK Schleswig-Holstein, Campus Kiel, Kiel, Germany
  • 2Klinik und Poliklinik für Herz, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Mainz, Germany
  • 3Klinik für Herzchirurgie, Herzzentrum Leipzig GmbH, Leipzig, Germany
  • 4Abteilung für Kardiochirurgie, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany
  • 5Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany
  • 6Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
  • 7Klinik für THG-Chirurgie, Universitätsklinikum Tübingen, Tübingen, Germany
  • 8Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg UKE, Hamburg, Germany
  • 9Klinik für Herz- und Gefäßchirurgie, HKZ GmbH & Co. Betriebs KG, Rotenburg a.d.Fulda, Germany
  • 10Herzzentrum, Klinik für Herzchirurgie, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany
  • 11Deutsches Herzzentrum München des Freistaates Bayern, Klinik für Herz- und Gefäßchirurgie, München, Germany
  • 12 Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany
  • 13Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie [DGTHG], Langenbeck-Virchow-Haus, Berlin, Germany
  • 14Klinik für Herzchirurgie, Universitätsklinikum Bonn, Bonn, Germany
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.