Contribution of cardiac surgeons in transcatheter aortic valve replacement activity in France.

Abstract

Objectives: This study provides a thorough analysis of cardiac surgeons' involvement in transcatheter aortic valve replacement (TAVR) activities in France, covering decision-making, procedural roles, training and outcome analysis.

Methods: A nationwide survey was sent to all cardiac surgeons and all cardiac surgery trainees in France. Subgroup analysis was performed for age, status (established versus in-training) and type of practice facility.

Results: A total of 172 surgeons from both private and public sectors responded to the survey. Most respondents (71%) had TAVR activity, and there were no significant differences between subgroups. Most respondents with TAVR activities (30%) had average access (once per week). Almost one-third of centres had >3 established surgeons with TAVR activity, whereas 19% had no in-training surgeons with TAVR activity. TAVR was the only structural practice for 67% of surgeons, while 33% practiced other structural procedures. When asked, 82% of surgeons were against establishing TAVR programmes in centres without a cardiac surgery programme. Most TAVR patients (72%) were discussed by the Heart Team, and only 9% of surgeons said their relationship with the interventional cardiologist was disrupted. Two-thirds of vascular complications were managed by cardiac surgery, and only 6% of cardiac surgeons admitted were unfit to handle any vascular complications.

Conclusions: In France, cardiac surgeons are becoming increasingly involved in TAVR procedures as an integral part of the Heart Team.