Why vascular surgeons must play a role in TAVI


Having a vascular surgeon as part of the transcatheter aortic valve implantation (TAVI) multidisciplinary team has a significant impact on decreasing the number of deaths caused by vascular complications, according to Marc van Sambeek, Catharina Hospital, Eindhoven, The Netherlands. Van Sambeek presented data supporting the participation of a vascular surgeon in the Heart Team at the VEITHsymposium (14–18 November 2012, New York, USA).

Van Sambeek spoke about “Why vascular surgeons must play a role in TAVI procedures”. He told delegates that data from the PARTNER trial Cohort B (TAVI vs. medical therapy in inoperable patients), published in 2010 in the New England Journal of Medicine, showed that TAVI was associated with a 16.2% rate of vascular complications, against 1.1% for medical therapy (p<0.001) at 30 days. Van Sambeek added that the PARTNER trial Cohort A (TAVI vs. surgery in high-risk patients) results also showed an increased risk of vascular complications with TAVI (17% vs. 3.8%, p<0.001 for any complications and 11% vs. 3.2%, p<0.001 for major complications).

He noted that a meta-analysis including 12 studies and 1,223 TAVI patients and published in the Journal of Invasive Cardiology in 2011 showed a mortality rate of 9.7%. Vascular complications, Van Sambeek said, were the cause of death in 17% of the cases, and “were the second leading cause of death in this study”.

The meta-analysis also showed that, of the 26 patients who died of bleeding/vascular complications, 20 died in the perioperative period and six died after 30 days.

Van Sambeek went on to present the experience at the Catharina Hospital. He said that 239 procedures have been performed since 2008. The mean age of the patients was 80.4 years, logistic Euroscore was 18.6, and 50.6% were male. The 30-day mortality rate was 9.2% and one-year mortality was 17%. In the PARTNER trial Cohort B one-year mortality was 31% with TAVI and 51% with medical therapy. At the Catharina Hospital, the rate of major vascular complication was 4.1% and of minor vascular complications was 7.5%. “There were no cases of access related mortality,” Van Sambeek said.

Van Sambeek stated that TAVI is a good alternative for conventional surgery with low mortality and morbidity rates. He concluded that the key to success is a well trained, consistent team including an interventional cardiologist, vascular surgeon, anaesthesiologist and cath lab staff.

Read the full article and an interview with Marc van Sambeek in the January 2013 issue of Vascular News.