In 2012, Transcatheter Aortic Valve Replacement (TAVR) became commercially available in the US to treat high-risk patients with severe aortic stenosis. It offered effective, minimally invasive, and often lifesaving treatment to tens of thousands of patients who previously had no option for aortic valve replacement surgery.
What started as an alternative form of aortic valve replacement for patients who were too high-risk for traditional surgery is now emerging as a viable standard-of-care therapy irrespective of surgical risk. The wide-ranging success of TAVR across the surgical risk spectrum has spurred the meteoric rise of what was previously a small field in cardiology – Structural Heart Disease.
In addition to TAVR, many other technologies have been developed to treat severe structural heart conditions with varying degrees of success. Often, these catheter-based procedures attempt to replicate contemporary surgical techniques. For instance, the MitraClip ™ procedure replicates the edge-to-edge mitral valve repair developed by Ottavio Alfieri (eponymously termed the Alfieri stitch) for severe mitral regurgitation. In 2018, catheter-based options are now available to treat aortic stenosis, mitral regurgitation, ASD/PFO, and paravalvular leaks. While these technologies have been a welcome minimally invasive addition to the toolbox for treating patients with challenging heart conditions, it has also created a more nuanced treatment algorithm for an already complex group of patients. This is especially true as TAVR seeks a low risk indication from the FDA. Fortunately, this nuance can be overcome by the use of a Heart Team.
A Heart Team typically refers to a group of cardiologists, cardiac surgeons, imagers, anesthesiologists, specialized nurses, and even gerontologists working together to arrive at a consensus decision of care for patients. This concept was initially adopted as a means of replacing turf wars with teamwork for the betterment of patients. Since then, it has been featured prominently in the valvular heart disease guidelines. In fact, the 2014 Valvular Heart Disease Guidelines published jointly by the ACC and AHA give the use of Heart Teams a class I indication when intervention for valvular heart disease is being considered.
At Brookwood Medical Center, this team-oriented approach to patient care is the core ethos by which the cardiovascular service line operates. We meet regularly to discuss all of our patients referred for cardiovascular interventions. We have found this approach to be indispensable in our mission to achieve the best outcomes for our patients.
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