How Many Aortic Valve Repairs Are Really Performed in Germany?

I read with great interest the report by Gummert and colleagues on cardiac surgery in Germany in 2008, published in the September issue of the “Thoracic and Cardiovascular Surgeon” [1], and was very surprised to read the low numbers of aortic valve repair procedures (n = 135). Considering the increasing number of repairs performed during the last few years, probably not only in our facility (where the number of aortic valve repairs performed in 2008 was 84), the data published possibly do not correspond to the real numbers. The difference may be explained by the difficulty of encoding aortic repair in the OPS code system. The only possibility to code isolated aortic valve repair in this system is number 5–353.0 used to indicate valvuloplasty by aortic valve narrowing (Valvuloplastik: Aortenklappenraffung), which among modern repair has a minor, perhaps even just a historical importance.

Certainly, there are some conditions in which an aortic regurgitation can be rectified by root repair alone or even by supracoronary ascending aorta replacement, but the majority of cases present with pathological changes of the valve cusps without root pathology or combined with only a slight dilatation of the ascending aorta. One could argue whether, in the latter group, root repair is the main procedure to be completed by valve repair or only an adjunct to valve repair. For the latter, the facts speak for themselves: root repair performed leaving the pathological cusps untouched does not lead to an abolishment of the valve defect. Moreover, a complete root repair (of all 3 sinuses) is seldom necessary. In 2008 we performed 38 isolated aortic valve repairs and 46 repairs combined with root surgery; of these only 17 patients required repair of all three sinuses of Valsalva. All root repairs were carried out using our own single-patch valve-sparing technique [2], which offers possibility of limiting the extent of the valve-sparing root repair and saving the valuable time for an inevitable repair.

Because codes for various methods of root repair already exist, I would suggest that they are used only for isolated root procedures and that new codes should be introduced that would allow simple and clear identification of isolated aortic valve repair and complex aortic valve and root repair procedures.

References

• 1 Gummert J F, Funkat A, Beckmann A, Schiller W, Hekmat K, Ernst M, Haverich A. Cardiac surgery in Germany during 2008. A report on behalf of the German Society for Thoracic and Cardiovascular Surgery.  Thorac Cardiovasc Surg. 2009;  57 315-323
• 2 Urbanski P P. Valve-sparing aortic root repair with patch technique.  Ann Thorac Surg. 2005;  80 839-844