2019 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter mitral valve intervention

Balancing the expansion of transcatheter interventions for heart valve disease

“…Considering the clinical (i.e., age, general clinical status, quality of life, frailty, comorbidities, other valves diseases, surgery impediments) and anatomical (i.e., femoral access status, aortic root morphology, size of aortic annulus, aortic valve morphology, concomitant coronary artery disease, coronary ostia origins, concomitant aortopathy) variables to be assessed in selecting the treatment for aortic stenosis, several HT members from different specialties (clinical cardiologist, cardiac imaging specialist, cardiac anaesthesiologist, and other medical specialists) continue to play a key role in this novel decision-making process. While the composition of the HT for aortic stenosis remains substantially unchanged, for the treatment of MR it becomes crucial to include the active participation of heart failure and mitral imaging specialists 4 . Indeed, evidence derived from randomised trials has shown that for functional MR the MitraClip device offers additional clinical benefits to optimal medical therapy in selected symptomatic patients with the strict echocardiographic criteria adopted in the COAPT trial 2 .…”

“…Thus, the right clinical patient selection for MitraClip implantation is essential for the effectiveness of this treatment. Regarding decision making for MR treatment, assessment of surgical risk by the HT remains the basis 4 . Thus, with some adaptation, the multidisciplinary approach guided by the surgeon and the interventional cardiologist coordinating different partnerships remains the essential mainstay of any successful catheter-based VHD therapy implementation.…”

“…Also, current resource constraints in healthcare, along with the need to provide increasingly timely access to care, highlight the importance of the imperative implementation of minimalist pathways, including early discharge, in the management of VHD patients. Beyond the individual hospital logistic, it is time to organise regional or national valve network systems of care including centres with defined standards criteria to guarantee the highest quality of care 3,4 . A recent consensus has proposed a network model based on a two-tier valve centre system 6 .…”