Transcatheter aortic valve implantation (TAVI) by centres with and without an on-site cardiac surgery programme: preliminary experience from the German TAVI registry.

Published

Journal Article

AIMS: To analyse patient characteristics, decision-making processes, and outcomes of TAVI performed in hospitals with versus those without on-site cardiac surgery (CS). METHODS AND 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.

Full Text

Duke Authors

Cited Authors

  • Eggebrecht, H; Mehta, RH; Haude, M; Sack, S; Mudra, H; Hein, R; Brachmann, J; Gerckens, U; Kuck, K-H; Zahn, R; Sechtem, U; Richardt, G; Schneider, S; Senges, J

Published Date

  • September 2014

Published In

Volume / Issue

  • 10 / 5

Start / End Page

  • 602 - 608

PubMed ID

  • 25256201

Pubmed Central ID

  • 25256201

Electronic International Standard Serial Number (EISSN)

  • 1969-6213

Digital Object Identifier (DOI)

  • 10.4244/EIJV10I5A105

Language

  • eng

Conference Location

  • France