title: [Commentary by the German Society for Thoracic and Cardiovascular Surgery on the positions statement by the German Cardiology Society on quality criteria for transcatheter aortic valve implantation (TAVI)].
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.
authors.affiliation: Klinik für Herz- und Gefäßchirurgie, UK Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.affiliation: Klinik und Poliklinik für Herz, Thorax- und Gefäßchirurgie, Universitätsmedizin Mainz, Mainz, Germany.
authors.forename: Markus K
authors.initials: MK
authors.lastname: Heinemann
authors.affiliation: Klinik für Herzchirurgie, Herzzentrum Leipzig GmbH, Leipzig, Germany.
authors.forename: Friedrich Wilhelm
authors.initials: FW
authors.lastname: Mohr
authors.affiliation: Abteilung für Kardiochirurgie, Herz- und Gefäß-Klinik GmbH, Bad Neustadt, Germany.
authors.forename: Anno
authors.initials: A
authors.lastname: Diegeler
authors.affiliation: Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany.
authors.forename: Friedhelm
authors.initials: F
authors.lastname: Beyersdorf
authors.affiliation: Klinik für Herz- und Gefäßchirurgie, UK Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Heidi
authors.initials: H
authors.lastname: Niehaus
authors.affiliation: Klinik für Thorax- und Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ensminger
authors.affiliation: Klinik für THG-Chirurgie, Universitätsklinikum Tübingen, Tübingen, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schlensak
authors.affiliation: Klinik und Poliklinik für Herz- und Gefäßchirurgie, Universitäres Herzzentrum Hamburg UKE, Hamburg, Germany.
authors.forename: Hermann
authors.initials: H
authors.lastname: Reichenspurner
authors.affiliation: Klinik für Herz- und Gefäßchirurgie, HKZ GmbH & Co. Betriebs KG, Rotenburg a.d.Fulda, Germany.
authors.forename: Ardawan
authors.initials: A
authors.lastname: Rastan
authors.affiliation: Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg, Bad Krozingen, Freiburg, Germany.
authors.forename: Georg
authors.initials: G
authors.lastname: Trummer
authors.affiliation: Herzzentrum, Klinik für Herzchirurgie, Kerckhoff-Klinik GmbH, Bad Nauheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Walther
authors.affiliation: Deutsches Herzzentrum München des Freistaates Bayern, Klinik für Herz- und Gefäßchirurgie, München, Germany.
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Lange
authors.affiliation: Klinik für Herz-, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
authors.affiliation: Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie [DGTHG], Langenbeck-Virchow-Haus, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Beckmann
authors.affiliation: Klinik für Herzchirurgie, Universitätsklinikum Bonn, Bonn, Germany.
authors.forename: Armin
authors.initials: A
authors.lastname: Welz
mesh_terms: D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality / Q000592:standards*; D032921:Consensus; D005858:Germany; D006350:Heart Valve Prosthesis / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000401:mortality / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D007391:International Cooperation; D010348:Patient Care Team / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome