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Interventioneller Herzchirurg

Konzept der Zukunft oder vergebene Mühe?

Interventional cardiac surgeon

Concept of the future or waste of time?

  • Karriere und Perspektiven
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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Katheterbasierte Techniken zur Behandlung struktureller Herzerkrankungen wie die kathetergestützte Aortenklappenimplantation (TAVI) oder die MitraClip-Prozedur nehmen seit Jahren zu. Vor allem im Bereich der TAVI-Prozedur ist die Herzchirurgie nach wie vor stark im Sinne des Heart-Team-Gedankens eingebunden. Um hier ein guter Partner zu sein, ist es notwendig, über eine breite Basis an Grundkenntnissen und -fertigkeiten zu verfügen. Diese reicht von der Kenntnis der aktuellen Literatur bis hin zu Grundfertigkeiten im Umgang mit Kathetern und Drähten. Die Aneignung dieser Grundfertigkeiten ist aktuell kein fester Bestandteil der kardiochirurgischen Ausbildung und daher jedem im Heart-Team tätigen Herzchirurgen selbst überlassen. Der vorliegende Beitrag bietet einen Überblick für den interessierten herzchirurgischen Kollegen darüber, wo und wie er sich in katheterbasierten Techniken fortbilden kann. Außerdem soll die Diskussion angeregt werden, ob es sinnvoll wäre, einen Teil des herzchirurgischen Curriculums den katheterbasierten Techniken zu widmen bzw. eine Spezialbezeichnung „interventioneller Herzchirurg“ zu etablieren.

Abstract

Catheter-based techniques for the treatment of structural heart diseases, such as transcatheter aortic valve implantation (TAVI) or the MitraClip procedure have been increasing in numbers for years. Especially during TAVI procedures, cardiac surgeons are still strongly involved in the sense of the concept of a heart team. In order to be a good partner in the team, it is essential to have a broad basic knowledge and set of skills. This includes not only a good overview of the current literature but also basic skills in handling catheters and wires. Acquisition of these skills is not part of the current cardiac surgical training and is therefore the personal responsibility of each individual surgeon involved in a heart team. This article provides an overview for cardiac surgeons interested in transcatheter techniques as to how and where to acquire these skills. Additionally, it aims to provoke discussion on whether the training of catheter-based techniques should be part of the training curriculum in cardiac surgery or if it is necessary to establish a special discipline of “interventional cardiac surgeon”.

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Literatur

  1. Beckmann A, Funkat A‑K, Lewandowski J et al (2017) German heart surgery report 2016: the annual updated registry of the German society for thoracic and cardiovascular surgery. Thorac Cardiovasc Surg 65:505–518

    Article  Google Scholar 

  2. Bestehorn K, Eggebrecht H, Fleck E et al (2017) Volume-outcome relationship with transfemoral transcatheter aortic valve implantation (TAVI): insights from the compulsory German Quality Assurance Registry on Aortic Valve Replacement (AQUA). EuroIntervention 13:914–920

    Article  Google Scholar 

  3. Carroll JD, Vemulapalli S, Dai D et al (2017) Procedural experience for transcatheter aortic valve replacement and relation to outcomes: the STS/ACC TVT registry. J Am Coll Cardiol 70:29–41

    Article  Google Scholar 

  4. Cribier A, Eltchaninoff H, Bash A et al (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106:3006–3008

    Article  Google Scholar 

  5. Deeb GM, Reardon MJ, Chetcuti S et al (2016) 3‑year outcomes in high-risk patients who underwent surgical or transcatheter aortic valve replacement. J Am Coll Cardiol 67:2565–2574

    Article  Google Scholar 

  6. Eggebrecht H, Vaquerizo B, Moris C et al (2018) Incidence and outcomes of emergent cardiac surgery during transfemoral transcatheter aortic valve implantation (TAVI): insights from the European Registry on Emergent Cardiac Surgery during TAVI (EuRECS-TAVI). Eur Heart J 39:676–684

    Article  Google Scholar 

  7. Eltchaninoff H, Durand E, Cribier A (2018) TAVI durability beyond five years: no alarms, but stay alert. EuroIntervention 14:e380–e382

    Article  Google Scholar 

  8. Feldman T, Kar S, Elmariah S et al (2015) Randomized comparison of percutaneous repair and surgery for mitral regurgitation: 5‑year results of EVEREST II. J Am Coll Cardiol 66:2844–2854

    Article  Google Scholar 

  9. Holy EW, Kebernik J, Abdelghani M et al (2018) Long-term durability and haemodynamic performance of a self-expanding transcatheter heart valve beyond five years after implantation: a prospective observational study applying the standardised definitions of structural deterioration and valve failure. EuroIntervention 14:e390–e396

    Article  Google Scholar 

  10. Khera S, Kolte D, Gupta T et al (2017) Association between hospital volume and 30-day readmissions following transcatheter aortic valve replacement. Jama Cardiol 2:732–741

    Article  Google Scholar 

  11. Leon MB, Smith CR, Mack MJ et al (2016) Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med 374:1609–1620

    Article  CAS  Google Scholar 

  12. Mack MJ, Leon MB, Smith CR et al (2015) 5‑year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomised controlled trial. Lancet 385:2477–2484

    Article  Google Scholar 

  13. Bachmann MBD (2003) 25 years of coronary angioplasty: almost a fairy tale. Lancet 361:527 (2003, February 8)

    PubMed  Google Scholar 

  14. Obadia J‑F, Messika-Zeitoun D, Leurent G et al (2018) Percutaneous repair or medical treatment for secondary mitral regurgitation. N Engl J Med. https://doi.org/10.1056/NEJMoa1805374

    Article  PubMed  Google Scholar 

  15. Pasic M, Unbehaun A, Buz S et al (2015) Annular rupture during transcatheter aortic valve replacement: classification, pathophysiology, diagnostics, treatment approaches, and prevention. JACC Cardiovasc Interv 8:1–9

    Article  Google Scholar 

  16. Reardon MJ, Adams DH, Kleiman NS et al (2015) 2‑year outcomes in patients undergoing surgical or self-expanding transcatheter aortic valve replacement. J Am Coll Cardiol 66:113–121

    Article  Google Scholar 

  17. Reardon MJ, Van Mieghem NM, Popma JJ et al (2017) Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. N Engl J Med 376:1321–1331

    Article  Google Scholar 

  18. Serruys PW, Modolo R, Reardon M et al (2018) One-year outcomes of patients with severe aortic stenosis and an STS-PROM of less than three percent in the SURTAVI trial. EuroIntervention. https://doi.org/10.4244/EIJ-D-18-00460

    Article  PubMed  Google Scholar 

  19. Søndergaard L, Steinbrüchel DA, Ihlemann N et al (2016) Two-year outcomes in patients with severe aortic valve stenosis randomized to transcatheter versus surgical aortic valve replacement: the all-comers nordic aortic valve intervention randomized clinical trial. Circ Cardiovasc Interv. https://doi.org/10.1161/CIRCINTERVENTIONS.115.003665

    Article  PubMed  Google Scholar 

  20. Stone GW, Lindenfeld J, Abraham WT et al (2018) Transcatheter mitral-valve repair in patients with heart failure. N Engl J Med. https://doi.org/10.1056/NEJMoa1806640

    Article  PubMed  Google Scholar 

  21. Sündermann S, Unbehaun A, Meyer A et al (2016) Wire skills for the surgeon - Femoral access safety net and vascular closure devices in transfemoral transcatheter aortic valve implantation procedures. Multimed Man Cardiothorac Surg. https://doi.org/10.1510/mmcts.2016.008

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Klinik für Kardiovaskuläre Chirurgie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland

    S. H. Sündermann

  2. Klinik für Herz‑, Thorax- und Gefäßchirurgie, Deutsches Herzzentrum Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    S. H. Sündermann,  A. Unbehaun &  J. Kempfert

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  1. S. H. Sündermann
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  2. A. Unbehaun
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  3. J. Kempfert
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Correspondence to S. H. Sündermann.

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Interessenkonflikt

S.H. Sündermann, A. Unbehaun und J. Kempfert geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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Aus Gründen der besseren Lesbarkeit wird in diesem Beitrag überwiegend das generische Maskulinum verwendet. Dies impliziert immer beide Formen, schließt also die weibliche Form mit ein.

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Sündermann, S.H., Unbehaun, A. & Kempfert, J. Interventioneller Herzchirurg. Z Herz- Thorax- Gefäßchir 33, 128–134 (2019). https://doi.org/10.1007/s00398-018-0284-0

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  • DOI: https://doi.org/10.1007/s00398-018-0284-0

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