SCAI/AATS/ACC/STS Issue Recommendations For Transcatheter Valve Programs

In an effort to establish the core competencies and technical skills required for providers and institutions who offer transcatheter treatment options to patients, a newly issued document has been published offering first-time guidance on developing and maintaining a transcatheter mitral valve therapy program.

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The consensus paper, "Operator & Institutional Requirements for Transcatheter Valve Repair and Replacement, Part II – Mitral Valve," was developed by a committee of cardiac surgeons and interventional cardiologists from the ACC, Society for Cardiovascular Angiography and Interventions, American Association for Thoracic Surgery and The Society of Thoracic Surgeons, and was published May 14 in the Journal of the American College of Cardiology.

Using a catheter to place a clip on the mitral valve and reduce leakage, transcatheter mitral valve therapy has developed into the only alternative treatment option to open heart surgery, making it an essential course of treatment for high-risk patients. "As these techniques continue to increase in use, we must promote consistent, best practices and standards of care for providers and institutions so that patients get the best possible care," says Carl L. Tommaso, MD, FACC, chair of the writing committee and medical director of the cardiac catheterization lab, NorthShore University HealthSystem Skokie Hospital, Evanston, IL. "These recommendations will help build and maintain programs centered on the best interests of patients."

Throughout its proposed recommendations, the new guidelines emphasize the need for a multi-disciplinary team approach, involving both surgeons and interventional cardiologists with extensive knowledge and diagnostic skills related to valvular disease. "Multidisciplinary teams have been shown to improve outcomes in complex procedures," says David A. Fullerton, MD, FACC, president of the Society of Thoracic Surgeons. "Working together to set the standard of care improves patient treatment and outcomes by building and maintaining quality, effective programs."

The guidelines also highlight the need that operators, regardless of their specialty, should have a thorough understanding of valvular heart disease and have the ability to interpret echocardiographic and other radiographic images. On an institutional level, the authors stress that each facility should have an active valvular heart disease surgical program with at least two institutionally based cardiac surgeons experienced in valvular surgery and should have available a full range of diagnostic imaging and therapeutic facilities. Lastly is the advocacy that long-term outcomes reports and participation in data registries should be mandatory for existing and new programs to further ensure accurate data collection on survival and complications, as well as to determine the risk and long-term durability of devices.

"As we assess novel new treatments and techniques evolve, professional associations will continue to champion quality improvement for all providers in the best interest of patients," said Fullerton.

Keywords: Writing, Cardiac Catheterization, Standard of Care, Diagnostic Imaging, Data Collection, Quality Improvement, Registries, Surgical Instruments, Cardiology, Heart Valve Diseases, Thoracic Surgical Procedures, Cardiac Surgical Procedures, Mitral Valve

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