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Differences in Risk Assessment of Percutaneous Aortic Valve Replacement Between Cardiologists and Cardiac Surgeons

From the Departments of Economics (T.G.) and Internal Medicine I (J.S.), Friedrich-Schiller-University, Jena, Germany.

Correspondence to Julia Schumm, MD, Department of Internal Medicine I, Erlanger Allee 101, D-07740 Jena, Germany. E-mail julia.schumm{at}med.uni-jena.de

Received October 14, 2008; accepted June 16, 2009.

Background— Percutaneous aortic valve replacement (PAVR) for aortic stenosis is an attractive alternative to operative valve replacement. Several devices are evaluated, but their efficacy and safety are critically discussed. An interdisciplinary approach with collaboration of cardiac surgeons and cardiologists is widely requested. We analyzed how cardiologists and cardiac surgeons assess the possibilities and risks of PAVR and whether there are substantial differences between the judgments of these 2 groups.

Methods and Results— Fifty-one cardiologists and 54 cardiac surgeons from German hospitals completed an online questionnaire consisting of 11 questions dealing with typical risks and benefits of PAVR. Answers to all questions differed significantly between surgeons and cardiologists. Risks as impaired hemodynamic outcome, paravalvular leakage, or embolic events were deemed higher for PAVR than for an operation from both groups, but cardiologists rated those risks significantly lower than cardiac surgeons (P<0.01 for all questions). A regression analysis with a latent variable approach for possible advantages of PAVR (like minor operative trauma, faster recovery, less pain) showed that the fact of being a cardiologist has a significant impact on the rating of PAVR advantages (r=0.719, P<0.01), whereas personal experience showed no significant effect.

Conclusions— Cardiologists and cardiac surgeons agree on possible risks and advantages of PAVR, but the extent differs significantly between the 2 groups. Cardiologists have a far more optimistic view of PAVR and are likely to favor an interventional approach. More and better evidence based information may help to overcome group related prejudices.

Key Words: heart valves • balloon valvuloplasty • risk assessment

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