Stakeholder Collaboration Key to Evolving Valve Management Strategies

The epidemiology of valvular heart disease (VHD) has changed dramatically over the past 50 years. In the U.S. alone, up to 1.5 million people have moderate or severe aortic stenosis (AS) and approximately 4 million people have significant mitral regurgitation (MR). Clinicians face several challenges in identifying and treating patients with valvular heart disease, particularly AS and MR.

To help better address these challenges, the College recently hosted a two-day Evolving Heart Valve Management Strategies Roundtable that brought together experts from 28 organizations representing a wide variety of medical specialties, industry, patients, integrated health systems and other stakeholder groups, as well as representatives from the U.S. Food and Drug Administration and the Centers for Medicare and Medicaid Services.

Roundtable participants were tasked with reviewing existing research regarding the evaluation and management of VHD, identifying gaps in care, and finding ways to integrate current evidence with tools and resources that can improve care and outcomes for VHD patients. Early discussions focused on existing ACC clinical documents, including Clinical Practice Guidelines, Performance Measures and Appropriate Use Criteria (AUC), as well as criteria that might help define heart valve Centers of Excellence. Emphasis was placed on identifying ways to make recommendations for practice more readily available at the point of care.

Participants also discussed new challenges in the management of AS and MR, the evolving indications for transcatheter aortic valve replacement (TAVR) and the emerging field of transcatheter mitral valve interventions. Among the top challenges identified were appropriate recognition and referral of patients with significant VHD, variability in the performance and interpretation of echo, inconsistent application of mitral valve repair, lack of readily available individual provider and hospital outcome data, new paradigms for training interventionists and surgeons, and barriers to innovation in the U.S. The importance of patient involvement, akin to that seen with diseases such as Marfan syndrome and hypertrophic cardiomyopathy, was also an important topic. Two patients were on hand to share their experiences in navigating their treatment courses. They provided vital feedback that will be helpful in developing new patient tools and in training clinicians.

Roundtable Chair Laura Mauri, MD, MSc, FACC, noted that the roundtable provided an “opportunity to act.” It also underscored the importance of stakeholder collaboration in the evolving area of VHD. Moving forward, the outcomes of the Roundtable will be used to inform the ACC’s efforts to develop practical guidance related to VHD strategies, especially transcatheter therapies, to improve patient care.

The ACC Evolving Valve Management Roundtable Planning Committee

The Evolving Valve Management Strategies Roundtable, an activity of the Valvular Heart Disease Initiatives, was supported by the Founding Sponsors: Abbott Vascular and Edwards Lifesciences, and the additional sponsor: Medtronic. For more information about VHD, join the discussion in the Valvular Heart Disease Clinical Topic Collection. Patient resources are also available at

Clinical Topics: Cardiac Surgery, Congenital Heart Disease and Pediatric Cardiology, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and CHD and Pediatrics, Cardiac Surgery and Heart Failure, Cardiac Surgery and VHD, Congenital Heart Disease, CHD and Pediatrics and Interventions, CHD and Pediatrics and Quality Improvement, Interventions and Structural Heart Disease, Mitral Regurgitation

Keywords: Aortic Valve Stenosis, Cardiomyopathy, Hypertrophic, Centers for Medicare and Medicaid Services (U.S.), Cooperative Behavior, Heart Valve Diseases, Humans, Marfan Syndrome, Medicaid, Medicare, Mitral Valve, Mitral Valve Insufficiency, Patient Care, Patient Participation, Point-of-Care Systems, Referral and Consultation, Surgeons, Transcatheter Aortic Valve Replacement, United States, United States Food and Drug Administration

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