Societies emphasize multidisciplinary team management in mitral valve repair
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Having a multidisciplinary team is key to managing patients being considered for transcatheter mitral valve interventions, according to a multisociety expert consensus systems of care document.
Because this patient population is complex, “it is essential that the cornerstone of a program to manage patients with mitral regurgitation is a formal, collaborative multidisciplinary team with expertise in valvular heart disease, HF, electrophysiology, cardiac imaging, interventional cardiology, cardiac valve surgery and cardiac anesthesia,” the document stated, which was written by representatives from the American Association of Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. “The principal goal of these programs must be to provide the best possible patient-centered care.”
Robert O. Bonow, MD, MS, MACC, vice chair for development and innovation, Max and Lilly Goldberg Distinguished Professor of Cardiology and professor of medicine at Northwestern University Feinberg School of Medicine, past president of the American Heart Association and chair of the writing group, and colleagues outlined skillsets necessary for members of the multidisciplinary team. These include:
- an echocardiography expert who can interpret transthoracic and transesophageal echocardiograms and an implanting physician who can interpret intraprocedural images;
- completion of training programs in accordance with FDA approval requirements of transcatheter mitral valve devices;
- understanding of basic radiation safety practices needed for optimal imaging and operator and patient protection;
- appropriate catheter and wire skills, including transseptal access to the mitral valve, and training in the interpretation of mitral valve hemodynamics; and
- prior experience with transcatheter aortic valve replacement, although this by itself is not enough experience to perform transcatheter mitral valve repair.
Institutions should have “a full range of diagnostic imaging and therapeutic facilities,” including a cath lab or hybrid operating room with a sterile environment and a variety of interchangeable equipment, an accredited echocardiography laboratory, a noninvasive vascular laboratory, CT and MRI laboratories, postprocedural recovery and intensive care facilities and outpatient facilities sufficient for adequate pre- and postprocedural care.
“Most importantly, there must be dedication on the part of the institution to provide these services and support, both financially and with no time constraints on the staff involved,” Bonow and colleagues wrote.
The members of the multidisciplinary team should include an interventional cardiologist, a cardiac surgeon, a general cardiologist with experience in valvular heart disease, an HF specialist with experience in advanced HF and transplantation, imaging specialists with experience in echocardiography, CT and MRI, a cardiac anesthesiologist, physician assistants and nurse practitioners, a patient navigator/program coordinator, a data manager and a hospital administrator, the authors wrote. – by Erik Swain
Disclosures: Bonow reports no relevant financial disclosures. Please see the statement for the other authors’ relevant financial disclosures.
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