[Transcatheter aortic valve implantation: surgeon's view].
OBJECTIVE
The technology of catheter- based aortic valve implantation is a new, less invasive therapeutic option for patients with symptomatic high-grade aortic stenosis. The present paper aims to demonstrate that optimal therapy should be provided by a multidisciplinary team consisting of cardiac surgeons, cardiologists and cardioanesthesiologists in a hybrid suite.


METHODS
From June 2007 to April 2009, 234 patients have been treated by transcatheter aortic valve implantation through different access sites (n = 168 femoral artery, n = 56 left ventricular apex, n = 7 subclavian artery, n = 3 ascending aorta) at the German Heart Center Munich, Germany. An algorithm for the choice of the most appropriate access site for the individual patient was established.


RESULTS
The 30-day mortality was 11.2% in this high-risk patient cohort. A certain number of periprocedural complications required surgical management. There was a considerable clinical improvement of the patients 6 months after the procedure.


CONCLUSIONS
Integrating the new methods of aortic valve implantation into a cardiac surgery program, all kinds of surgical and interventional treatment options may be offered to the patient with aortic stenosis by one multidisciplinary team. A qualified and safe performance of transcatheter aortic valve implantation and the management of potential complications require the presence of a hybrid suite.
Bleiziffer
Sabine
S
Klinik für Herz- und Gefässchirurgie, Deutsches Herzzentrum München, München, Germany. bleiziffer@dhm.mhn.de
Bauernschmitt
Robert
R
Ruge
Hendrik
H
Mazzitelli
Domenico
D
Schreiber
Christian
C
Hutter
Andrea
A
Opitz
Anke
A
Lange
Rüdiger
R
D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D006328:Cardiac Catheterization / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006350:Heart Valve Prosthesis / Q000706:statistics & numerical data*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality*; D006801:Humans; D008297:Male; D010348:Patient Care Team; D015995:Prevalence; D016019:Survival Analysis; D015996:Survival Rate