Consult aortic valve replacement cardiac surgeon first

In case of an aortic valve replacement, consult the cardiac surgeon beforehand

12/19/2011

In aortic valve replacement with the aid of transcatheter aortic valve implantation, the success of treatment depends crucially on the experience of the clinic and the operating physician. The German Heart Foundation refers to this in a recent statement. Patients should therefore insist that they not only speak with a cardiologist, as is often the case, but also with a specialist in cardiac surgery. The experience of the clinic and an existing specialist department for cardiac surgery are crucial for the success of the therapeutic goal.

TAVI is used at a higher risk
Transcatheter aortic valve implantation (TAVI) is performed in patients in whom open heart surgery would be too risky. If the heart is open, the patient should be connected to a heart-lung machine. At-risk patients include, above all, older people over the age of 75, patients with previous cardiac surgery and those with diagnosed heart failure, renal insufficiency or pulmonary hypertension. The TAVI is minimally invasive, with an aortic valve replacement valve in the collapsed state is inserted by catheter from the inguinal artery in the heart. In this process, the existing heart valve is then covered with a new one. A heart valve replacement is necessary if, for example, the heart valve is calcified and its tasks can no longer perform properly. Affected then suffer from severe symptoms such as shortness of breath and dizziness.

To insist on a previous conversation with a cardiac surgeon
To install an aortic valve replacement, a so-called transcatheter aortic valve implantation is necessary. In this procedure, an aortic valve is newly replaced to improve cardiac output. But patients should be careful: Before such a difficult procedure should be spoken not only with the cardiologist, but also with the treating cardiac surgeon. On such a conversation „Patients should exist“, like Prof. dr. med. Thomas Meinertz of the initiative „German Heart Foundation e.V.“ in Frankfurt am Main said. In a personal interview prior experience and case numbers of the clinic can be queried, since it is not sufficient for optimal surgery when patients are examined and educated only by the cardiologist.

The patient should ask for information on what experience the selected hospital has on Transcatheter Aortic Valve Implantation (TAVI) during a consultation. According to the expert, the operation is risky if the clinic only has a small number of cases per year. „Success depends on experience“, like the doctor in the in-house newspaper „Heart today“ stressed.

Aortic valve registers a valuable reference
Another important quality-assured indication for a low-risk treatment is the participation of the clinic in the aortic valve registry. The registry collects patient data for which a replacement flap has been inserted and evaluates it from a scientific point of view. Among other things, it is determined which special procedure is best for which patient group from a medical point of view. Therefore, sufferers should undergo surgery only in such clinics, which also participate in the aortic valve registry.

Cardiac surgeon should be available during the procedure
During heart surgery, a specialist in cardiac surgery should definitely be available to intervene immediately in case of complications, explained the expert Meinertz. It would be even better if the cardiologist and the cardiac surgeon carry out the procedure together. It is also helpful if the clinic has a specialist department for cardiology and cardiac surgery. Accordingly, the operating room should be equipped for open heart surgery as well as for procedures with the cardiac catheter. In an emergency, it can then be resorted to.

Every year more than 11,000 heart valve interventions are performed in Germany. Included in these case numbers are about 3600 TAVI implants. This corresponds to an approximate share of 23.9 percent (2010). Patients suffering from aortic stenosis complain mainly of chest pain, shortness of breath, dizziness or fainting under stress. Because many times a therapy with drugs does not promise improvement, flap defects are principally operated on. Which method is used depends on the condition of the patient. (Sb)

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Picture: Martin Büdenbender