title: Transcatheter aortic valve implantation (TAVI) by centres with and without an on-site cardiac surgery programme: preliminary experience from the German TAVI registry.
abstract: OBJECTIVE
  To analyse patient characteristics, decision-making processes, and outcomes of TAVI performed in hospitals with versus those without on-site cardiac surgery (CS).
  
  
  RESULTS
  Current guidelines mandate transcatheter aortic valve implantation (TAVI) to be performed at hospitals with both cardiology and on-site CS departments. Some hospitals in Germany perform TAVI without CS departments in-house. We analysed the data of 1,432 patients enrolled in the German TAVI registry at 27 hospitals between January 2009 and June 2010. Nineteen of these had on-site CS (group 1), while eight centres performed TAVI with no CS department at their institution (group 2). Patients in group 2 (n=178, 12% of the overall study population) were older than in group 1 (mean age 82.6±6.3 years vs. 81.6±6.2 years) with similar logistic EuroSCORE (average: 21%). Patients in group 2 were haemodynamically more stable (higher blood pressures, better ejection fraction, less low-flow or low-gradient aortic stenosis, and less urgent procedures). Procedure times and use of contrast were higher in group 2. The procedural success rate was higher in group 1 (98% vs. 95%). Post-procedural complications were similar in the two groups with 30-day mortality of 6.2% in group 2 compared with 8.3% in group 1 patients.
  
  
  CONCLUSIONS
  Only 12% of patients enrolled in the German TAVI registry underwent TAVI at hospitals without an on-site CS department. Overall patient characteristics appeared to be similar, although patients in non-CS centres appeared to be haemodynamically more stable and more often had a history of previous heart surgery. Despite longer procedures, complication rates were similar. These preliminary data in a modest number of patients suggest the feasibility of performing TAVI in appropriately selected patients at hospitals without CS but this requires confirmation in future studies involving a large number of patients.
authors.affiliation: Cardioangiologisches Centrum Bethanien (CCB) and AGAPLESION Bethanien Hospital, Frankfurt, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Eggebrecht
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: Michael
authors.initials: M
authors.lastname: Haude
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.forename: Harald
authors.initials: H
authors.lastname: Mudra
authors.forename: Ralph
authors.initials: R
authors.lastname: Hein
authors.forename: Johannes
authors.initials: J
authors.lastname: Brachmann
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gerckens
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.forename: Gert
authors.initials: G
authors.lastname: Richardt
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D057510:Endovascular Procedures / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012042:Registries; D013903:Thoracic Surgery / Q000458:organization & administration; D014463:Ultrasonography