An updated Expert Consensus Systems of Care document provides operator and institutional recommendations and requirements for transcatheter mitral valve (MV) interventions. The document was developed by the ACC, the American Association for Thoracic Surgery (AATS), the Society for Cardiovascular Angiography and Interventions (SCAI), and the Society of Thoracic Surgeons (STS), and published Dec. 16 in the Journal of the American College of Cardiology.

The document is "similar in theme and intent" to the 2018 expert consensus systems of care document on recommendations and requirements for TAVR. The updated document provides guidance for operators and institutions to assess their potential for launching and/or maintaining a transcatheter MV intervention program.

Writing Committee Chair Robert O. Bonow, MD, MS, MACC, and Vice Chair Patrick T. O'Gara, MD, MACC, et al., note that specifically, the document focuses on the overarching goal of improving patient outcomes across all transcatheter MV sites and providing guidance regarding the use of data and analyses for program assessment. The document also combines site process and outcome measures, and the recommendations have been updated with the clinical, registry and trial knowledge gained since the initial 2014 document was published.

In addition, the authors explain the importance and function of a multidisciplinary team and recommend that sites incorporate shared decision-making strategies. Regarding outcome requirements, the authors note that risk adjustment models for transcatheter MV procedural outcomes are under development. They further note 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 1-year outcome tracked by the Centers for Medicare and Medicaid Services."

Moving forward, the authors conclude that "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. Nevertheless, the guiding principles and foundational elements included in this and companion multisociety documents constitute an enduring commitment to optimizing patient outcomes."

The document will also be co-published in the Journal of Thoracic and Cardiovascular Surgery, the Annals of Thoracic Surgery, and Catherization and Cardiovascular Interventions and reprinted in the Journal of Cardiac Failure.

Keywords: Thoracic Surgery, Risk Adjustment, Mitral Valve, Patient Selection, Transcatheter Aortic Valve Replacement, Medicaid, Medicare, Registries, Thoracic Surgical Procedures, Heart Failure, Outcome Assessment, Health Care, Angiography, Surgeons, Patient Care Team

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