Cardiac surgery at a high level

Total number of cardiac surgery continues to be stable; Consistent adherence to medical guidelines required; Cardiac surgeons strive to further improve patient safety; further falling number of donor hearts

01/29/2014

The total number of interventions in the 79 cardiac surgery departments in Germany remains stable at a high level, ensuring cardiac surgery nationwide. This is clear from the figures of the Heart Report 2013, which was presented to the public on Wednesday. As in previous years, around 100,000 cardiac surgeries were performed in 2012 as well. At the same time, demographic change is ensuring that the age of cardiac surgery patients continues to rise. For this reason, concomitant diseases are more common in patients who require special attention in surgical treatment. German cardiac surgeons have responded to this development by establishing minimally invasive, gentler surgical procedures so that patients' survival rates of more than 95 percent are maintained. These very good results, especially in international comparison, speak for a high-quality care, which the German Society for Thoracic and Cardiovascular Surgery (DGTHG) would like to further improve in the years to come. With regard to medical care and patient safety in particular, DGHTG believes that the three pillars are high-quality treatment „Qualified doctors as well as nursing and assistant personnel“, „Structured processes“ and „Suitable infrastructure“ decisively.

Aortic valve implantation: Follow medical guidelines
The DGTHG continues to criticize the disproportionately high increase in catheter-assisted aortic valve implantation in which the calcified aortic valve is first pressed onto the vessel wall with a balloon before a biological heart valve prosthesis is implanted after sufficient expansion. In 2012, according to the figures available for catheter-assisted aortic valve implantation, such interventions were carried out contrary to the recommendations of the specialist societies in patients under 75 and with a low risk profile, which contradicts the medical guideline published in 2012 jointly by the European specialist societies of cardiologists and cardiac surgeons. „For the benefit of patients, the consistent implementation of this guideline would be necessary. For which patients, in addition to the very old, multimorbid persons, this still relatively new procedure is still considered, the long-term results from the German Aortic Valve Registry will first be shown“, says Professor Jochen Cremer, President of the DGTHG.

The DGTHG also strongly advocates fully adhering to the further requirements of the guideline for the treatment of valvular heart disease. An essential criterion in the development of the guideline was patient safety. Therefore, it has been agreed by cardiologists and cardiac surgeons in the guideline that qualified physicians, structured processes and appropriate infrastructure must be present in the field to enable continuous treatment and, in the event of complications with the necessary expertise and expertise, to share the patient with the patient to be able to rescue life-threatening situations occurring in this therapy.

Stabilization in the number of bypass operations
More than half of cardiac surgery on the heart once again involved coronary artery bypass graft surgery in 2012. In comparison with 2011, there is a stabilization of approximately 55,000 bypass surgeries in 2011. From the point of view of the DGTHG, this is a sign of a more decision-making decision as far as medical and medical aspects are concerned in the therapy decision. Several studies have shown that bypass surgery, especially with multiple coronary artery infiltration and more complicated constrictions, is the better choice, particularly with regard to the survival and enduring quality of life of patients after the procedure. Therefore, the medical associations of cardiac surgeons and cardiologists have also established in medical guidelines that an interdisciplinary team consisting of a cardiac surgeon and a cardiologist should individually determine for each patient whether a bypass operation or a stent implantation is the correct therapy. „We advise the patient when choosing a clinic specifically to ask if such a heart team is available. If not, our recommendation is to seek the advice of both a cardiologist and a cardiac surgeon to make sure you get the best treatment for your individual case“, says Professor Anno Diegeler, secretary of the DGTHG.

Further decreasing number of donor hearts
From the point of view of cardiac surgeons, a dramatic development continues with the numbers of heart transplants in Germany. At the 22 transplant centers in Germany that transplant donor hearts, these interventions have declined significantly since 1997. And this negative trend continues: In 2012, 346 heart and heart lung transplants were performed in Germany, 20 fewer than in 2011. According to figures from Eurotransplant, heart transplants decreased to 297 in 2013 and heart-lung transplants to twelve. „We heart surgeons experience every day the suffering of our currently around 1,000 patients on the waiting lists. Due to their life-threatening disease state, many of these seriously ill people usually have to wait several months in an intensive care unit for the life-saving transplantation“, so Diegeler. To keep people alive until a suitable donor organ is available, but also due to the lack of donor heart increasingly as a permanent solution, is increasingly used by cardiac surgeons on cardiac support systems.

The German Society for Thoracic and Cardiovascular Surgery (DGTHG) represents the interests of more than 1,000 heart, thoracic and cardiovascular surgeons working in Germany in dialogue with politics, business and the public. (Pm)

Picture: Martin Büdenbender