Interview with Dr. Thomas Schmitz
Dr. Thomas Schmitz is a leading interventional cardiologist at one of Europe’s top cardiovascular centers — the Contilia Heart and Vascular Center at Elisabeth Hospital Essen — and a distinguished expert in heart diseases. He is also an active member of the European Society of Cardiology and the author of numerous innovations in the field of interventional cardiology.
Dr. Schmitz recently visited Georgia, where he took part in the International Congress of Interventional Cardiology. His presentation focused on the importance of modern cardiological technologies and the need to make them more accessible in Georgia. As one of Europe’s foremost specialists in cutting-edge techniques, he discussed methods that ensure faster and safer recovery for patients.
Given the increasing relevance of Transcatheter Aortic Valve Implantation (TAVI) — both globally and in Georgia — we asked Dr. Schmitz about the practical benefits of this procedure, its future prospects, and its role in reshaping patient care.
Levan.- For the patients and their loved ones considering a TAVI procedure, could you please tell us what the benefits of this procedure are compared to its predecessor, the standard of care os open heart surgery, in terms of the benefits in recovery or in outcomes?
Schmitz – The primary benefit is that you can do the complete pre-planning, like CT scan, angiography, in an ambulatory setting. So, the patient comes to the hospital for the procedure. This is day one or day zero. And if nothing special happens, the patient can go home after three days. If you compare this to open surgery, where normally the hospital stay is around two weeks, followed by 6-8 weeks in the recovery clinics, it’s much faster and safer for the patient.
Levan, and this recovery phase is completely avoided with the TAVI procedure?
Schmitz Yes. You have a small stitch in the groin, and if there are no problems, you can walk on day one, and you can go home on day three.
We tell our patients, if they are really fit, not to go traveling on a bicycle in the first two weeks, but then they can go, and they do it. That’s great.
Levan- Nowadays, it’s become more standard that higher numbers and younger patients choose to get this procedure, and the variety of patients who can qualify for it has also expanded. It used to be only for specific ailments in the past. Do you foresee a future where it might become standard of care nowadays?
Schmitz Yes. The future is now. I’m kidding, of course. So, nowadays, I would say, as I mentioned during my talk, if you are older than 75 and the CT scan shows no problems, then the standard of care is a TAVI procedure. If you are between 70 and 75, it’s a shared decision between the patient and the doctor to undergo surgery and a TAVI; and below, normally, the patient should be a surgical candidate. But we now have data showing that even patients who are 65 really benefit from this procedure. So, I would say, maybe this year we have a change in the guidelines that the limit of age limit goes down to 65. I would not go, at the moment, even lower because you have to think about the pacemaker rate. Pacemaker rate( need to implant a pacemaker) in TAVI procedures is between 10 and 12 percent. And if you are, for example, 50 and you have to live with a pacemaker for the next 40 years, if you are lucky, that might cause some issues. But we will also get data for this. But at the moment, we have this clear data for the age.
Levan, thank you. The point you mentioned is actually the topic of my next question. As for the longevity of the procedure for the patients who get it at a younger age, what are the current guidelines saying in terms of the long-term durability of the procedure?
Schmitz So, if you receive a TAVI procedure at a younger age, we now have data that the valve durability is similar to the surgical valve. So, there are no differences. So, it doesn’t matter if you get it surgically or via the valve. So, it is also not a problem if you see after 10 years, for example, that you have a valve deterioration. You can also see this in a surgical valve, because it’s the same material. Then you can do a valve-in-valve procedure. You can implant in the first TAVI a second TAVI. So, you have another 10, 15, 20 years. And I would say, at the moment, this procedure is the best you can do.
Levan Okay, thank you so much for that. As for my next question. Some of the recent studies, which I have been reading through PubMed, also highlight some of the more complications of the TAVI, such as the paravalvular leaks or the post-procedure arrhythmias. As these complications are being explored more and more, are there any advancements or new strategies being implemented to maybe mitigate them as much as possible?
Schmitz Yeah. So, we learned a lot in the last years. I will start with the pacemaker rate. Because in the beginning, we sometimes implanted the valves too deeply into the left ventricle. And then the pacemaker rate was very high. Nowadays, there is a special technique. It’s called commisural alignment. And using this method, we implant the valve higher. With this approach, the pacemaker rate dropped significantly. Therefore, nowadays, we are at around a 10% pacemaker rate. The second point is paravalvular leak. In the beginning, with moderate aortic regurgitation, you were still very happy. Nowadays, you should not accept any aortic regurgitation. Because in the beginning, you have to size your valve correctly according to the CT scan you got. And in the CT scan, you can see the problem of calcification. Is it circular? Is it going down to the LVOT? Where exactly is the calcification? And depending on this, you can choose the valve that fits best for the patient. It can be that you use a self-expandable valve or a balloon-expandable valve, something like this. And the companies also advanced their tools. You see, nowadays every valve has a skirt. And with this skirt, even if you have a little bit of paravalvular regurgitation, the skirt gets thicker over time, and the paravalvular regurgitation disappears. So they did a lot of research in this field. And it’s now our responsibility that the patient leaves the cath lab with, I would say, with no aortic regurgitation or just a trace of it.
Levan, thank you. A good point you mentioned is about the pre-operation procedures required to undergo the surgery, as compared to the open-heart procedures. How much different is the pre-op situation for the PAVI?
Schmitz Yeah. So, nowadays, in my opinion, it should be a standard for a surgeon to get a CT scan upfront, because with a CT scan, you can exactly measure the aortic annulus of the patient. In a lot of cases, when they perform open heart surgery, they have a special tool for sizing, thanks to which they choose a size and implant the valve.
However, we often see in several cases that the surgically implanted valve is too small for the patient. And that leads to a faster valve deterioration. And with a CT scan, you can avoid this.
We did a lot of development of new software in the CT, so I would say we are now at a very high level to be able to find the best procedures for the patient.
Levan, as a last question, I would like to discuss a very hot topic of recent months, the topic of AI, and its implementations in various fields. Do you foresee a future where it can be implemented, or is it already a part of the process in your field of work
Schmitz, I believe the future of AI in our field lies in CT scans. Currently, you upload a scan and manually take measurements, but soon, AI will handle that for you. I expect such tools to hit the market this year. Naturally, you’ll still need to verify the results, but AI will provide the data you need. Additionally, we might also have AI in the Cath lab. Imagine fluoroscopy images enhanced with CT measurements overlaid in real time. As you adjust the imaging angle, the AI will dynamically update measurements on screen. There’s a lot of development happening here.
Levan- All right, that’s great to hear. I believe we’re done with the interview. Thank you so much for taking the time to speak to us
Dr. Schmitz: Thank you. I’m glad that more and more people are getting interested into this topic. It means that in the future, more patients will choose the right, safe, and modern method of treatment.
