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Heart Report The cardiac surgery care in Germany is very good
Constant total number of manifold cardiac surgery procedures; Heart surgeons welcome measures to further improve patient safety and advocate a consistent heart team concept; further falling number of donor hearts
The total number of invasive interventions in the 78 cardiac surgery departments in Germany remains stable at a high level for 2014 as well. Thus, the heart surgery care nationwide has been secured for years. This is clearly shown by the figures, data and facts of the German Heart Report 2015, which was presented on January 27, 2016 in Berlin. In 2014, around 100,000 cardiac surgeries were performed again.
Increasing level in heart surgery. Image: Africa Studio - fotolia Cardiac surgeons take into account demographic change
In the context of the progressive demographic change in the population, cardiac surgery patients are also showing a steady increase in their age. In 2014, 74.6 percent of patients were at least 60 years old and two-thirds of all heart surgeries were performed on men. The German cardiac surgeons (913 cardiac surgeons and 47 thoracic and cardiovascular surgeons in Germany worked in 2014) are countering this development with the continuous development of surgical procedures and the establishment of minimally invasive, gentler surgical techniques. Thanks to these innovative developments, survival rates in elective patient groups continue to be well over 95 percent.
Coronary bypass surgery at a high level
In 2014, more than half of cardiac surgery on the heart involved coronary artery bypass graft surgery. In recent years, a large number of approximately 54,000 isolated and combined bypass operations have been reported annually. From the point of view of the DGTHG, this is a sign of decisions based on factual and medical considerations in the choice of therapy. Extensive studies show that coronary artery bypass grafting is a crucial factor in improving the quality of life, especially in multiple coronary arteries and more complex constrictions, especially with regard to the long-term survival of patients.
For example, the 5-year results of the Syntax study (international study of approximately 1,800 included patients with coronary heart disease) found that patients with complex coronary artery disease (CHD) who underwent coronary artery bypass grafting significantly increased within five years rarely die from a heart attack. "The more severe and complex coronary artery disease is, the more valuable and sustainable is complete recovery of coronary blood supply through a bypass operation," said Professor Armin Welz, President of DGTHG.
Medical societies recommend heart team
International medical societies of cardiac surgeons and cardiologists have reaffirmed in scientifically-based guidelines on coronary heart disease in 2014 that an interdisciplinary team consisting of cardiac surgeons and cardiologists should individually determine for each patient whether a bypass operation or a stent implantation to is recommended therapy. "When choosing a hospital, we advise patients to ask specifically whether a heart team is actively established, consistently available and regular consultations take place. If not, our recommendation is to seek advice from both a cardiologist and a cardiac surgeon to make sure you get the best treatment for your individual case, "said cardiac surgeon Prof. Welz. The ESC / EACTS "Guidelines on Myocardial Revascularization", updated in 2014, confirms chon, as does the National Care Guideline. KHK the concept of cooperation and decision-making in the heart team.
DGTHG is committed to decisive quality criteria
These very good results, especially in international comparison, speak for a high-quality care, which the German Society of Thoracic and Cardiovascular Surgery (DGTHG) would like to continuously improve over the next few years. With regard to high-quality medical care and patient safety, the DGHTG believes that three aspects are of particular importance for the treatment of the heart: the qualifications of the occupational groups involved (doctors, nurses, cardiac technicians, medical assistants), the differentiated and comprehensible structuring of the treatment processes and suitable infrastructural prerequisites.
Invasive heart valve interventions - patient safety is the top priority
Across Europe, the narrowing of the aortic valve (aortic valve stenosis) is one of the most common heart valve diseases, which occurs due to wear, especially in old age. By minimally invasive and gentler surgical techniques today even very elderly patients with significant concomitant diseases can be successfully treated. For example, in Transcatheter Aortic Valve Implantation (TAVI), the "heart valve prosthesis" is introduced using special catheters either through the blood vessels (transvascular) or over the apex (transapical) and deployed after displacement of the defective aortic valve. While the number of TAVI interventions has increased enormously in recent years, there has recently been an increase in catheter-assisted mitral valve treatments.
The DGTHG sees an urgent need to continuously support the introduction of these new procedures through medical registries and controlled trials, and to use such innovations with a strict indication only to a limited extent in selected multimorbid patients until short-, medium- and long-term scientific findings are available. According to the opinion of the Heart Surgical Society, patient safety must comply with the recommendations of a corresponding guideline of the European Association for Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC). In Germany, in 2015, the Federal Joint Committee (G-BA) stipulated mandatory quality standards for catheter-assisted aortic valve implantation (TAVI) and mitral valve clip procedures in the "Guideline on minimally invasive heart valve interventions". "For the time being, the TAVI and clip procedures at the mitral valve should only be considered in interdisciplinary consensus with carefully selected patients presenting with particular risks, as it has not yet been conclusively clarified whether similar long-term survival rates can be achieved with this intervention alternative, such as with the established heart operations, "explains Welz.
Number of donor hearts continues to drop
From the point of view of cardiac surgeons, a dramatic development continues with the numbers of heart transplants in Germany. In 2013, 297 heart and heart-lung transplants were performed in Germany (Eurotransplant). According to the German Foundation for Organ Transplantation (DSO), heart transplants decreased to 294 in 2014. "We heart surgeons experience every day the suffering of our currently around 1,000 patients on the waiting list. Due to their life-threatening illness, many of these critically ill patients usually have to wait several months in the hospital or even in an intensive care unit for life-saving transplantation, "explains Welz. To keep the patients alive until a suitable donor organ is available, cardiac surgeons are increasingly implanting cardiac assist systems in recent years. "In the absence of donor hearts, some cardiac support systems are implanted into patients with a long-term perspective," says Welz. (Pm)