In this post I link to and excerpt from the American College of Cardiology’s Ten Points To Remember on “2019 Expert Consensus to Optimize Care for Patients With Heart Valve Disease”. Apr 19, 2019 | David S. Bach, MD, FACC.
The above article references 2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease. J Am Coll Cardiol 2019;Apr 19:[Epub ahead of print].
The 2019 Expert Consensus above is well worth reviewing in its entirety by clinicians and patients.
Here are excerpts from the Ten Points To Remember article [The series is called Ten Points but there are only 7 points in this article]:
Providing optimal care to patients with valvular heart disease (VHD) is an increasingly complex process. This document proposes a system of care for patients with VHD, with goals of improving patient outcomes. The following are key points to remember:
- The proposed integrated model of care for patients with VHD is based on a concept of a graduated system, with an initial tier of recognition and consideration for referral, followed by matching the patient based on disease complexity with the appropriate center of expertise and available resources. The model includes the primary care physician and general cardiologist, either of whom can refer patients to either a Level II Primary Valve Center or a Level I Comprehensive Valve Center, with potential additional referrals between the Valve Centers.
- The initial step in the management of patients with VHD is recognition and subsequent diagnosis, usually by a primary care physician, advanced practice provider, or general cardiologist. The second step in management often involves referral to a local general cardiologist for further refinement of the diagnosis, initiation of any indicated medical therapy, and identification of patients who can be followed for the time being without intervention and those for whom more specialized care should be considered.
- [Please see article].
- Primary (Level II) Valve Centers should at a minimum have the expertise and resources to perform surgical aortic valve replacement (SAVR) with or without coronary artery bypass grafting (CABG), and transfemoral transcatheter AVR (TAVR). The ability to perform a durable mitral valve repair in patients with primary mitral regurgitation (MR) caused by isolated posterior leaflet pathology is desirable but not mandatory.
- Comprehensive (Level I) Valve Centers should have the resources and capabilities to evaluate and perform all commercially available interventional and surgical procedures, including TAVR using nontransfemoral approaches and valve-in-valve TAVR, transcatheter mitral valve edge-to-edge repair, and percutaneous closure of paravalvular leaks; and complex surgical procedures including complex aortic root procedures including valve-sparing root repair, and the ability to treat patients with complicated infective endocarditis.
- All Valve Centers require consistent access to high-quality echocardiography and an echocardiographer with expertise in VHD. In addition, Comprehensive (Level I) Centers should have advanced imaging modalities including 3D echocardiography and cardiac magnetic resonance imaging. Interventional echocardiographers (blending a sophisticated knowledge of echocardiography with clinical expertise to guide management decisions and interventions) also are integral to patient management at Level I Centers.
- [Please see article]