title: The role of the heart team in complicated transcatheter aortic valve implantation: a 7-year single-centre experience.
abstract: OBJECTIVE
  European guidelines recommend to perform transcatheter aortic valve implantation (TAVI) within a multidisciplinary heart team. However, there is a strong drive--despite existing guidelines--to perform TAVI outside of specialized centres. The aim of this study was to clarify the necessity of on-site cardiac surgery by providing a clear insight into the complications during/after TAVI that needed surgical management.
  
  
  METHODS
  A total of 2287 (1523 transfemoral, 752 transapical and 12 transaortic) patients, with a mean age of 84.5 ± 5.3 years, and a mean log EuroSCORE of 21.7 ± 16.3, of which 205 were female (84%), underwent TAVI since February 2006 at our institution. All procedure-related complications that required surgical interventions, whether immediate or delayed but within the initial hospital stay, were recorded and retrospectively analysed.
  
  
  RESULTS
  Out of this cohort, 245 (10.7%) patients required surgical treatment due to major complications. A total of 42 patients (1.8%) underwent conversion to full sternotomy and 27 (1.2%) were dependent on the short-term use of the heart-lung machine. Vascular complications with surgical intervention were seen in 85 patients (3.7%), 54 patients (2.4%) had to have a rethoracotomy within their initial stay and 15 (0.7%) required a cardiac reoperation.
  
  
  CONCLUSIONS
  Severe complications during TAVI that can only be resolved surgically will continue to occur. Therefore, each TAVI procedure should be conducted or accompanied by a cardiac surgeon and an experienced team within a specialized centre.
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany philipp.kiefer@medizin.uni-leipzig.de p.kiefer@med.uni-leipzig.de.
authors.forename: Philipp
authors.initials: P
authors.lastname: Kiefer
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Seeburger
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Thilo
authors.initials: T
authors.lastname: Noack
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schröter
authors.affiliation: Department of Cardiology, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.affiliation: Department of Cardiology, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Haensig
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Marcel
authors.initials: M
authors.lastname: Vollroth
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Department of Cardiac Surgery, University of Leipzig, Heart Center, Leipzig, Germany.
authors.forename: David Michael
authors.initials: DM
authors.lastname: Holzhey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D010348:Patient Care Team; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000401:mortality* / Q000706:statistics & numerical data*
keywords: Complication; Heart team; TAVI; Transcatheter