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Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI)

Joint Consensus Document of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte e.V. (ALKK) and cooperating Cardiac Surgery Departments

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Abstract

Indications for TF-TAVI (transfemoral transcatheter aortic valve implantation) are rapidly changing according to increasing evidence from randomized controlled trials. Present trials document the non-inferiority or even superiority of TF-TAVI in intermediate-risk patients (STS-Score 4–8%) as well as in low-risk patients (STS-Score < 4%). However, risk scores exhibit limitations and, as a single criterion, are unable to establish an appropriate indication of TF-TAVI vs transapical TAVI vs SAVR (surgical aortic valve replacement). The ESC (European Society of Cardiology)/EACTS (European Association for Cardio-Thoracic Surgery) guidelines 2017 and the German DGK (Deutsche Gesellschaft für Kardiologie)/DGTHG (Deutsche Gesellschaft für Thorax-, Herz- und Gefäßchirurgie) commentary 2018 offer a framework for the selection of the best therapeutic method, but the individual decision is left to the discretion of the heart teams. An interdisciplinary TAVI consensus group of interventional cardiologists of the ALKK (Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte e.V.) and cardiac surgeons has developed a detailed consensus on the indications for TF-TAVI to provide an up-to-date, evidence-based, comprehensive decision matrix for daily practice. The matrix of indication criteria includes age, risk scores, contraindications against SAVR (e.g., porcelain aorta), cardiovascular criteria pro TAVI, additional criteria pro TAVI (e.g., frailty, comorbidities, organ dysfunction), contraindications against TAVI (e.g., endocarditis) and cardiovascular criteria pro SAVR (e.g., bicuspid valve anatomy). This interdisciplinary consensus may provide orientation to heart teams for individual TAVI-indication decisions. Future adaptations according to evolving medical evidence are to be expected.

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Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI).

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Acknowledgements

Interdisciplinary Working Group members: W. von Scheidt, A. Welz, M. Pauschinger, T. Fischlein, V. Schächinger, H. Treede, R. Zahn, M. Hennersdorf; TAVI-Consensus-Group members: J. M. Albes, R. Bekeredjian, M. Beyer, J. Brachmann, C. Butter, L. Bruch, H. Dörge, W. Eichinger, U. F. W. Franke, N. Friedel, T. Giesler, R. Gradaus, R. Hambrecht, M. Haude, H. Hausmann, M. P. Heintzen, W. Jung, S. Kerber, H. Mudra, T. Nordt, L. Pizzulli, F.-U. Sack, S. Sack, B. Schumacher, G. Schymik, U. Sechtem, C. Stellbrink, C. Stumpf, H. M. Hoffmeister. Members of the ALHK (Arbeitsgemeinschaft Leitende Herzchirurgische Krankenhausärzte e.V.): T. Fischlein, W. Eichinger, U. F. W. Franke, H. Hausmann, F.-U. Sack.

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Authors and Affiliations

  1. I.Medizinische Klinik, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156, Augsburg, Germany

    Wolfgang von Scheidt

  2. Klinik und Poliklinik für Herzchirurgie, Rheinische-Friedrich-Wilhelms-Universität Bonn, Bonn, Germany

    A. Welz & H. Treede

  3. Medizinische Klinik 8, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany

    M. Pauschinger

  4. Klinik für Herzchirurgie, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Nuremberg, Germany

    T. Fischlein

  5. Medizinische Klinik I, Klinikum Fulda, Herz-Thorax-Zentrum Fulda, Fulda, Germany

    V. Schächinger

  6. Medizinische Klinik B, Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany

    R. Zahn

  7. Medizinische Klinik I, SLK-Kliniken Heilbronn, Heilbronn, Germany

    M. Hennersdorf

  8. Abteilung Herzchirurgie, Immanuel Klinikum Bernau, Herzzentrum Brandenburg, Brandenburg, Germany

    J. M. Albes

  9. Abteilung für Kardiologie, Robert-Bosch-Krankenhaus Stuttgart, Stuttgart, Germany

    R. Bekeredjian

  10. Klinik für Herz- und Thoraxchirurgie, Universitätsklinikum Augsburg, Herzzentrum Augsburg-Schwaben, Augsburg, Germany

    M. Beyer

  11. II.Medizinische Klinik Kardiologie, Angiologie, Pneumologie, Regiomed-Kliniken, Klinikum Coburg, Coburg, Germany

    J. Brachmann

  12. Abteilung Kardiologie, Immanuel Klinikum Bernau, Herzzentrum Brandenburg, Brandenburg, Germany

    C. Butter

  13. Innere Medizin/Kardiologie, Unfallkrankenhaus Berlin, Berlin, Germany

    L. Bruch

  14. Klinik für Herz- und Thoraxchirurgie, Klinikum Fulda, Herz-Thorax-Zentrum Fulda, Fulda, Germany

    H. Dörge

  15. Klinik für Herzchirurgie, Klinikum München, München-Bogenhausen, Munich, Germany

    W. Eichinger

  16. Abteilung für Herz- und Gefäßchirurgie, Robert-Bosch-Krankenhaus, Stuttgart, Germany

    U. F. W. Franke

  17. Klinik für Herz- und Thoraxchirurgie, Klinikum Bayreuth, Bayreuth, Germany

    N. Friedel

  18. Klinik für Kardiologie und Angiologie, MediClin Herzzentrum Coswig, Coswig, Germany

    T. Giesler

  19. Klinik für Herz- und Kreislauferkrankungen, Klinikum Kassel, Kassel, Germany

    R. Gradaus

  20. Klinik für Kardiologie und Angiologie, Klinikum Links der Weser, Bremen, Germany

    R. Hambrecht

  21. Medizinische Klinik I, Städtische Kliniken Neuss, Lukaskrankenhaus, Neuss, Germany

    M. Haude

  22. Klinik für Herz- und Gefäßchirurgie, MediClin Herzzentrum Coswig, Coswig, Germany

    H. Hausmann

  23. Medizinische Klinik II, Klinik für Herz- und Gefäßerkrankungen, Klinikum Braunschweig, Brunswick, Germany

    M. P. Heintzen

  24. Klinik für Innere Medizin III, Kardiologie und Intensivmedizin, Schwarzwald-Baar Klinikum, Villingen-Schwenningen, Germany

    W. Jung

  25. Klinik für Kardiologie I, Herz- und Gefäßklinik Bad Neustadt, Bad Neustadt an der Saale, Germany

    S. Kerber

  26. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany

    H. Mudra

  27. Klinik für Herz- und Gefäßkrankheiten, Klinikum Stuttgart, Stuttgart, Germany

    T. Nordt

  28. Kardiologie, Gemeinschaftskrankenhaus Bonn, Bonn, Germany

    L. Pizzulli

  29. Klinik für Herzchirurgie, Herzzentrum Ludwigshafen, Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany

    F.-U. Sack

  30. Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Schwabing, Städtisches Klinikum München, Munich, Germany

    S. Sack

  31. Klinik für Innere Medizin 2, Westpfalz Klinikum Kaiserslautern, Kaiserslautern, Germany

    B. Schumacher

  32. Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany

    G. Schymik

  33. Abteilung für Kardiologie, Robert-Bosch-Krankenhaus, Stuttgart, Germany

    U. Sechtem

  34. Klinik für Kardiologie und Internistische Intensivmedizin, Klinikum Bielefeld, Bielefeld, Germany

    C. Stellbrink

  35. Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin, Klinikum Bayreuth, Bayreuth, Germany

    C. Stumpf

  36. Klinik für Kardiologie und Allgemeine Innere Medizin, Städtisches Klinikum Solingen, Solingen, Germany

    H. M. Hoffmeister

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  1. Wolfgang von Scheidt
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  2. A. Welz
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  3. M. Pauschinger
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  4. T. Fischlein
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  7. R. Zahn
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  9. J. M. Albes
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  11. M. Beyer
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  13. C. Butter
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  15. H. Dörge
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  17. U. F. W. Franke
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  18. N. Friedel
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  19. T. Giesler
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  20. R. Gradaus
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  21. R. Hambrecht
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  22. M. Haude
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  24. M. P. Heintzen
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  25. W. Jung
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  26. S. Kerber
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  27. H. Mudra
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  28. T. Nordt
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  29. L. Pizzulli
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  30. F.-U. Sack
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  31. S. Sack
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  32. B. Schumacher
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  33. G. Schymik
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  34. U. Sechtem
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  35. C. Stellbrink
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  36. C. Stumpf
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  37. H. M. Hoffmeister
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Correspondence to Wolfgang von Scheidt.

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von Scheidt, W., Welz, A., Pauschinger, M. et al. Interdisciplinary consensus on indications for transfemoral transcatheter aortic valve implantation (TF-TAVI). Clin Res Cardiol 109, 1–12 (2020). https://doi.org/10.1007/s00392-019-01528-5

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