Klinikum Nürnberg opened first TAVI Center in Northern Bavaria
Life saving aortic valve replacement option with excellent result
An increasing number of patients suffers from aortic valve disease. This particularly affects the elderly population aged over 75 years; narrowing of the aortic valve found in around 3% of patients, and consequently restricting blood flow into the aorta. About half of these patients die within two years if aortic valve disease remains untreated.
Successful aortic valve replacement surgery gives them hope that they can live a full and high quality life. Conventional heart surgery bears a high risk particularly in elderly patients over 75 years old with major medical comorbidities. TAVI stands for „Transcatheter Aortic Valve Implantation“, and revolutionized in recent years treatment of aortic valve conditions in the elderly population, and for patients in whom surgical treatment is contraindicated or is associated with a high risk of morbidity and mortality.
The TAVI Center based at Klinikum Nürnberg was the first hospital in Northern Bavaria accredited in June, 2016 by the German Cardiac Society as „TAVI CENTER“; health council standards of TAVI excellence certification program were initially introduced in April 2015. So far, the only TAVI Centers are located in Munich, Passau and Regensburg, and in all of Germany, there is a total number of 24 accredited TAVI Centers.
More than 150 Transcatheter Aortic Valve Implantations performed each year
As Professor Dr. Matthias Pauschinger, full professor, Head of Department of Cardiology and University Hospital of Paracelsus Medical Private University in Nürnberg, explained during a press conference held at Klinikum Nürnberg on 17th June, 2016: „This accreditation certifies that we meet the high standards in medical resources, competent health professionals including technical facilities and organizational requirements set forth by the German Cardiac Society for the complex treatment of patients with aortic valve stenosis providing necessary skills and expertise for TAVI procedure“. Klinikum Nürnberg meets the strict requirements complying with the guidelines currently in effect and established by the Mutual German Federal Commission with regard to quality assurance provisions.
Since July 2009, the Heart Team at Klinikum Nürnberg has performed over 670 transcatheter aortic valve implantation procedures, and program volume of around 150 TAVI performed in 2015. A catheter with a precisely fitted and folded bioprosthetic valve is inserted into a femoral artery, and bioprosthetic valve is deployed. Alternatively transapical valve insertion technique may be applied. In total, around 250 surgical aortic valve replacement procedures are annually performed at Klinikum Nürnberg.
Our multi-disciplinary „Heart Team“ is using state-of-the-art technology
As Dr. Jürgen Jessl, Senior Consultant, Department of Cardiology at Klinikum Nürnberg explains:„Fundamental to the establishment of our transcatheter valve program is the development of a multi-disciplinary “Heart Team“, consisting of a formal multi-disciplinary collaboration from the very beginning between interventional cardiologist, cardiac surgeons, anesthesiologists, including additional specialists, if necessary. Multi-disciplinary collaboration facilitated after best possible structural conditions were completed in March 2011.
The newly opened and modern Heart and Vascular Center located at Klinikum Nürnberg, Campus South, bringing together cardiologists, cardiac surgeons and vascular surgeons. The Heart and Vascular Center is in close vicinity and organizationally connected with the different types of intensive care units and specialist departments at Klinikum Nürnberg, Campus South. The Heart and Vascular Center includes cutting-edge hybrid operating rooms and cardiac catheterization laboratories. Appropriate equipment for the procedure and for dealing with possible complications during catheterization allow the cardiac surgeon performing on-site emergency surgical interventions.
Decisions on treatment options are considered in a formal case conference involving the members of the Heart Team
In close collaboration with cardiologists, cardiac surgeons and anesthesiologists decision making is complex in relation to the patients most likely to benefit from conventional surgery or transcatheter aortic valve implantation. Cases are discussed in formal case conferences on a regular basis involving the Heart Team. Is the risk for conventional surgery in this patient expected to be too high? What are potential complications for this procedure? Does this patient suffer from other conditions, for instance circulatory disorders or pulmonary disorders, in which case low-risk TAVI procedure is indicated. As Univ.-Prof. Dr. Axel Junger, full professor, Head of Department of Anesthesiology and Intensive Care at Klinikum Nürnberg explained: „Individual cardiovascular risk factors play an important role“. Medical guidelines and studies are setting the standards for treatment recommendations.
Both types of surgical interventions, conventional surgeries and TAVI procedures, bear risks and have benefits. „Conventional surgery is the gold-standard treatment for patients up to 75 years of age. In most cases, minimally invasive surgery is performed where the surgeon makes a small incision. As Privatdozent Dr. Steffen Pfeiffer, Lecturer of University, Senior Consultant of the Department of Cardiac Surgery at Klinikum Nürnberg explained: „Conventional surgery bears a reduced risk“. TAVI procedures are indicated for older patients and high-risk co-morbid patients.
Complication rates of TAVI procedures and registry of outcomes recorded in a national database
But there are also risks involved in performing TAVI procedures: Typical complications include leaky heart valves, pacemaker dependency and vascular complications. In recent years, however, the number of high-risk patients with relevant conditions has significantly decreased. Meanwhile studies on the TAVI procedure are available over a 10-year time. Quality and outcome of treatments of aortic valve stenosis is monitored in a national database registry, where all nationwide surgical interventions, a total number of 25,000 procedures, both conservative surgical interventions and TAVI procedures are recorded, and mutually operated in collaboration between cardiologists and cardiac surgeons.
Essential Requirements for TAVI Accreditation:
1. Typically a Heart Team could include, but is not limited to, the following:
- 2 interventional cardiologists and 2 cardiac surgeons providing all the necessary skills and expertise in performing TAVI procedures
- Development of a multi-disciplinary Heart Team (consisting of 2 interventional cardiologists + 2 cardiac surgeons + 2 anesthesiologists)
2. A minimum of 50 TAVI procedures per annum
3. Modern facilities including hybrid operating room / catheterization laboratory
4. Cardiac surgeon performing a minimum of 25 procedures annually
5. Doctors available 24 hours a day
6. Participate in quality reporting to the nationwide database registry
Author: Unternehmenskommunikation (translation by International Department)