Multisociety expert consensus systems of care document 2019 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter mitral valve intervention: A Joint Report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and The Society of Thoracic Surgeons

Teamwork and Speed Bumps

“…the SYNTAX Trial, the ability to achieve comparable revascularization forms an important part of the basis of strategies of care used in other circumstances wherein joint regional Catheterization Laboratory and Surgical conferences, which included both CVS and IC, reviewed data together from their own hospitals to come to decisions about appropriate strategies of care. 10,13 When possible, in an in-person joint discussion with patient and family to discuss the risks and benefits of each approach is optimal. Although this second goal of an in-person joint discussion with the family was difficult to implement, it remained the ideal then as now in the current environment in which the two specialties should discuss relevant merits of alternative approaches before definitive recommendations are made for patient care.…”

“…Consideration of the optimal means by which to engage in joint decision-making and to provide patients and families with an objective review of treatment options formed the basis of the heart team concept, which initially incorporated Interventional Cardiology (IC) and Cardiovascular Surgery (CVS) team members. [2][3][4][5][6][7][8][9][10]…”

“…These have been reviewed and put in the context of multi-society expert consensus systems of care documents. 10 The Mitra-FR trial of 304 patients found no difference in the primary endpoint of all-cause death or unplanned hospitalization for heart failure at 12 months. In contrast, the larger COAPT trial carried out around the same time documented a marked reduction in all hospitalizations for heart failure within 24 months as well as a reduction in death from any cause.…”

“…Discussions from multiple stakeholders identified that the clinical benefits in COAPT were felt to be related to difference in the severity of the mitral regurgitation, the rigor of heart failure therapy, the procedural success rates, and the durability of mitral regurgitation reduction among others. 10 These important differences are best addressed by a…”

Complete transcatheter treatment of multiple heart valve diseases

“…Transcatheter heart valve (THV) therapies shed new light on effective treatment, not only in elderly, but also in patients with concomitant comorbidities such as porcelain aorta or those who have undergone chest radiation therapies and who are not appropriate candidates for surgery [1]. Transcatheter "edge to edge " -Mitra-and Tri-Clip repair together with transcather aortic valve implantation (TAVI) have been described as valuable therapy options for this subset of patients [2][3][4].…”