Cardiac surgery care at a high level



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Total number of cardiac surgeries remains stable; consistent observance of the medical guidelines is required; Cardiac surgeons strive to further improve patient safety; donor hearts continue to decline
29.01.2014

The total number of interventions in the 79 cardiac surgery departments in Germany remains stable at a high level, thus ensuring cardiac surgery care nationwide. This is made clear by the numbers in the 2013 Heart Report, which was presented to the public on Wednesday. As in previous years, around 100,000 heart operations were performed in 2012. At the same time, demographic change is causing the age of cardiac surgery patients to continue to rise. For this reason, there are also frequent concomitant diseases in patients that require special attention during surgical treatment. German cardiac surgeons have countered this development by establishing minimally invasive, gentler surgical procedures, so that patient survival rates of more than 95 percent continue to be achieved. These results, which are very good, especially in international comparison, speak for high-quality care, which the German Society for Thoracic, Cardiac and Vascular Surgery (DGTHG) would like to continue to improve in the coming years. With regard to medical care and in particular patient safety, the three pillars "Qualified doctors and nursing and assistant staff", "Structured processes" and "Appropriate infrastructure" are decisive for high-quality treatment from the DGHTG's point of view.

Aortic valve implantations: observe medical guidelines The DGTHG is also critical of the disproportionately high increase in catheter-supported aortic valve implantations in international comparison, in which the calcified aortic valve is first pressed against the vessel wall with a balloon before a biological heart valve prosthesis is implanted after sufficient expansion. In 2012, according to the available figures for catheter-supported aortic valve implantations, such operations were carried out against the recommendations of the specialist societies for patients under the age of 75 and with a low risk profile, which contradicts the medical guidelines published in 2012 by the European specialist societies of cardiologists and cardiac surgeons. "In the interest of the patients, however, the consistent implementation of this guideline would be necessary. The long-term results from the German Aortic Valve Register will only show for which patients in addition to the very old, multimorbid people mentioned, this still relatively new procedure will be considered, ”said Professor Jochen Cremer, President of the DGTHG.

The DGTHG also strongly advocates that the other requirements of the guideline for the treatment of heart valve diseases be fully complied with. An important criterion in the development of the guideline was patient safety. That is why cardiologists and cardiac surgeons jointly stipulated in the guideline that qualified doctors, structured processes and a suitable infrastructure must be available on site in order to enable continuous treatment and, in the event of complications with the necessary competence and the relevant specialist knowledge, to work together with the patient to be able to save life-threatening situations that occur with this therapy.

Stabilization in the number of bypass operations In 2012, more than half of cardiac heart surgeries again constituted coronary bypass surgery to treat coronary artery disease. In a year-on-year comparison between 2012 and 2011, there was stabilization with around 55,000 bypass procedures. From the DGTHG's point of view, this is a sign of a decision in the therapy decision that is more oriented towards factual medical considerations than before. Because various studies show that bypass surgery is the better choice, especially in the case of multiple coronary arteries and more complicated narrowing, especially with regard to the survival rate and the long-term quality of life of the patient after the respective procedure. For this reason, the specialist associations of cardiac surgeons and cardiologists in medical guidelines also stipulated in the treatment of this disease that an interdisciplinary team consisting of a cardiac surgeon and a cardiologist should jointly determine for each patient whether a bypass operation or a stent implantation is the right therapy . “When choosing a clinic, we advise patients to specifically ask whether such a cardiac team is available. If not, our recommendation is definitely to get advice from both a cardiologist and a cardiac surgeon to ensure that you really get the best treatment for your individual illness, ”says Professor Anno Diegeler, Secretary of the DGTHG.

Number of donor hearts continues to decline A dramatic development from the perspective of cardiac surgeons continues in the number of heart transplants in Germany. At the 22 transplant centers in Germany that transplant donor hearts, these interventions have decreased 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 Eurotransplant figures, heart transplants decreased to 297 in 2013 and heart-lung transplants to twelve . “We cardiac surgeons experience the suffering of our currently around 1,000 patients on the waiting lists every day. Because of their life-threatening condition, many of these seriously ill people usually have to wait several months in an intensive care unit for the life-saving transplant, ”said Diegeler. In order to keep people alive until a suitable donor organ is available, but also because of the lack of donor hearts more and more often as a permanent solution, cardiac surgeons are increasingly using cardiac support systems.

The German Society for Thoracic, Cardiac and Vascular Surgery (DGTHG), as a medical society, represents the interests of the more than 1,000 cardiac, thoracic and cardiovascular surgeons working in Germany in dialogue with politics, business and the public. (pm)

Image: Martin Büdenbender / pixelio.de

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