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Societies release overview of transcatheter MR therapies
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The American College of Cardiology, American Association for Thoracic Surgery, Society for Cardiovascular Angiography and Interventions, and The Society of Thoracic Surgeons recently released a societal overview outlining recommendations for the application of innovative treatments for mitral regurgitation. This overview was prompted by the recent FDA approval of the MitraClip device. Other technologies are expected to be brought forward in the years ahead.
According to the statement, patients should be assessed for mitral regurgitation (MR) anatomy and function, biventricular function, pulmonary artery pressures, size of cardiac chambers and other pathology related to the aortic or tricuspid valves.
The statement stresses the necessity of heart valve referral centers of excellence with standardized criteria for personnel and treatment.
These centers are defined by the competence and experience of clinicians and the presence of a multidisciplinary heart team that includes:
- General cardiologists;
- Heart valve and HF experts;
- Advanced imaging specialists;
- Interventionalists;
- Cardiac surgeons;
- Allied members of the heart team, including anesthesia, geriatrics, neurology, nephrology, nursing, care coordination, pharmacy, physical therapy and social work.
The centers of excellence must have a team that addresses all aspects of patient care through late follow-up and participates in the ongoing STS/ACC Transcatheter Valve Therapy (TVT) Registry to improve outcomes and regulate costs. Centers also should monitor data quality and publication of research projects from the registry.
The authors noted that a document is currently in development to outline standards for operator training and credentialing criteria for mitral valve procedures. The authors further note that the ongoing COAPT trial is investigating the role of the MitraClip (Abbott Vascular) in high surgical risk patients with functional MR, which could expand indications for its use beyond patients with prohibitive surgical risk degenerative MR.
“The authors and societies envision this document serving as a broad guideline for the responsible deployment of these new therapies for our patients and teams,” John H. Calhoon, MD, professor and chair of cardiothoracic surgery at The University of Texas Health Science Center at San Antonio and overview co-chair, said in a press release. “With this overview as a foundation, our societies will plan future documents to address appropriate data collection and use, best practices, team composition and further definition of patient characteristics.”
Disclosure: Calhoon reports no relevant financial disclosures. See the paper for a full list of all other authors’ relevant financial disclosures.
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