Indikationsstellung, Strukturen und Prozesse für die kathetergestützte Aortenklappenimplantation

Döbler, Klaus; Boukamp, K. B.; Mayer, Ernst

doi:10.1007/s00398-012-0911-0

Cited by 6 publications

(7 citation statements)

References 16 publications

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“…We could show that the procedure was perceived as significantly better. Still, this is only true for the current indication: older patients with severe symptomatic AS who are not suited for conventional procedures [ 10 ]. Considering the age of patients undergoing TAVI, the recommendations of the national and European cardiac and cardiothoracic societies and associations suggest a minimum age of 75 [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Still, this is only true for the current indication: older patients with severe symptomatic AS who are not suited for conventional procedures [ 10 ]. Considering the age of patients undergoing TAVI, the recommendations of the national and European cardiac and cardiothoracic societies and associations suggest a minimum age of 75 [ 10 ]. In the group of patients under the age of 75, the surgical intervention was considered superior to TAVI, although the respondents predicted changing recommendations for the near future.…”

Section: Discussionmentioning

confidence: 99%

“…This development has been repeatedly criticized [ 8 , 10 ]. Critics argue that the method had begun to diffuse widely, while at the same time, valid clinical evidence was still missing, especially in the consideration of which patients should be receiving the intervention [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…One explanation for the rapid diffusion of TAVI is found in the reimbursement policies and, accordingly, the cost of the procedure [ 8 – 10 ]. It can be assumed, however, that this is only one factor among many others.…”

Section: Introductionmentioning

confidence: 99%

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The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure

Merkel¹,

Eikermann²,

Neugebauer³

et al. 2015

Implementation Sci

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BackgroundThe transcatheter aortic valve implantation (TAVI), a minimally invasive surgical procedure to treat patients with severe symptomatic aortic stenosis, showed a rapid diffusion in Germany compared to the international level. The aim of this study is to identify and analyze factors affecting the implementation and diffusion of the procedure in hospitals using a qualitative application of the diffusion of innovations theory.MethodsWe conducted problem-centered interviews with cardiologists and cardiac surgeons working in German hospitals. The multi-level model “diffusion of innovations in health services organizations” developed by Greenhalgh et al. was used to guide the research. Data was analyzed using content and a thematic analysis.ResultsAmong the ten participants who were interviewed, we found both barriers and facilitators related to the innovation itself, system readiness and antecedents, communication and influence, and the outer context. Key issues were the collaboration between cardiologists and cardiac surgeons, reimbursement policies, requirements needed to conduct the procedure, and medical advantages of the method.ConclusionsThe findings show that there are multiple factors influencing the diffusion of TAVI that go beyond the reimbursement and cost issues. The diffusion of innovations model proved to be helpful in understanding the different aspects of the uptake of the procedure. A central theme that affected the implementation of TAVI was the collaboration and competition between involved medical departments: cardiology and cardiac surgery. Against this background, it seems especially important to moderate and coordinate the cooperation of the different medical disciplines.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The transcatheter aortic valve implementation (TAVI)—a qualitative approach to the implementation and diffusion of a minimally invasive surgical procedure

Merkel¹,

Eikermann²,

Neugebauer³

et al. 2015

Implementation Sci

View full text Add to dashboard Cite

show abstract

“…27 The criticisms support the view that the technology was, and still is being, used beyond proper indications and in treatment facilities not adequately equipped for emergencies. 23 The approach of the Food and Drug Administration, which waited until the PARTNER results were available before making a decision, shows the advantages of requiring some efficacy data before approval for market. In the US, TAVI was only ever approved for a restricted group of patients.…”

Section: The Tavi Experiencementioning

confidence: 99%