Consensus paper of the German Cardiac Society (DGK) and the German Society for Thoracic and Cardiovascular Surgery (DGTHG) on transcatheter aortic valve implantation (TAVI) 2020

Abstract

Following the two position papers of the German Cardiac Society (DGK) from 2015 and 2016 on transcatheter aortic valve implantation (TAVI), the DGK and the German Society for Thoracic and Cardiovascular Surgery (DGTHG) have decided to issue a consensus paper on the topic that takes into account the most recent results from randomized controlled trials and registries, with special emphasis on patients with severe aortic stenosis (AS) and low operative risk (STS score ≤4%). Specific indications, such as “valve in valve” and severe AS in patients with a bicuspid aortic valve are also addressed. Additionally, TAVI-related complications and the durability of percutaneously in comparison to surgically inserted prostheses are discussed, particularly in view of the generally younger age of low-risk patients. According to this consensus paper, surgical aortic valve replacement (SAVR) is recommended for low-risk patients ≤70 years without any of the risk factors known to be missing from the widely accepted risk scores. The TAVI procedure is recommended after heart team consensus for low-risk patients >75 years and a suitable anatomy for TAVI. In patients between 70 and 75 years old, a heart team decision between SAVR and TAVI is recommended that considers the patient’s life perspective in view of missing long-term data from randomized trials. Taking into account the decision of the Federal Joint Committee (G-BA) on percutaneous heart valve treatment, the personnel and structural prerequisites regarding the qualification of TAVI centers and TAVI surgeons, with the special roles of interventional cardiologists and cardiac surgeons, are defined.