According to Writing Committee Chair Robert O. Bonow, MD, MS, MACC, and Vice Chair Patrick T. O'Gara, MD, MACC, et al., the document combines site process and outcome measures, and includes updated recommendations that take into account the clinical, registry and trial knowledge gained since the initial 2014 document was published.

The importance and function of a multidisciplinary team, as well as incorporation of shared decision-making strategies are also important elements of the updated document.

Looking ahead, Bonow, O'Gara and colleagues note that risk adjustment models for transcatheter MV procedural outcomes are currently under development. They also highlight that "data to fulfill the requirements to maintain a safe, efficient, and effective MV intervention program can be generated from the STS/ACC TVT Registry and the STS Adult Cardiac Surgery Database with linkage to the one-year outcome tracked by the Centers for Medicare and Medicaid Services."

"Newer transcatheter systems for the treatment of severe MR are anticipated and it is expected that the proposed requirements herein will need to evolve with further advances in equipment, techniques, and patient selection," the authors write. "Nevertheless, the guiding principles and foundational elements included in this and companion multi-society documents constitute an enduring commitment to optimizing patient outcomes."

The updated expert consensus document was developed by the ACC, the American Association for Thoracic Surgery, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons (STS), and published in the Journal of the American College of Cardiology.

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The new AUC address 1,035 unique scenarios that include 324 clinical indications and up to seven imaging modalities offered per indication. Of these scenarios, 44 percent were rated Appropriate, 39 percent rated May Be Appropriate, and 17 percent rate Rarely Appropriate.

The document is broken down into 19 tables by the following clinical indications: Patent Foramen Ovale, Atrial Septal Defects and Partial Anomalous Pulmonary Venous Connection; Ventricular Septal Defects; Atrioventricular Septal Defects; Patent Ductus Arteriosus; Total Anomalous Pulmonary Venous Connection; Eisenmenger Syndrome and Pulmonary Hypertension Associated With CHD; Ebstein Anomaly and Tricuspid Valve Dysplasia; Pulmonary Stenosis; Pulmonary Atresia With Intact Ventricular Septum; Mitral Valve Disease; LVOT Lesions; Truncus Arteriosus; Single Ventricle Heart Disease; Aortic Coarctation and Interrupted Aortic Arch; Coronary Anomalies; Tetralogy of Fallot; Double Outlet Right Ventricle; D-Loop Transposition of the Great Arteries; and Congenitally Corrected Transposition of the Great Arteries.

In general, the Writing Group co-chaired by Ritu Sachdeva, MBBS, FACC, and Anne Marie Valente, MD, FACC, note that "while transthoracic echocardiography (TTE) remains the cornerstone of cardiac imaging in patients with CHD, other imaging modalities, such as transesophageal echocardiography (TEE), cardiovascular magnetic resonance (CMR), cardiovascular computed tomography (CCT), and stress imaging, also play an important role in anatomic and functional assessment."

"As lesion complexity increased, additional imaging modalities received higher appropriateness Ratings," Sachdeva, Valente and colleagues say.

While the scope of the document was purposefully limited to more common scenarios encountered when managing and treating established CHD patients, the hope is to help clarify appropriate use of multimodality imaging in these scenarios and help to minimize the significant variability in use that currently exists.

The newest AUC document was developed with the American Heart Association, American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Pediatric Echocardiography.

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