News
Heart teams remain the cornerstone of any transcatheter aortic valve replacement procedure, new credentialing recommendations for TAVR programs emphasized.
The document, released by four leading cardiovascular organizations, serves as a starting point for programs and institutions that want to assess their potential for implementing and/or maintaining a TAVR program.
"As new technologies begin to be incorporated into cardiovascular practice, it is the responsibility of the medical societies to work together to develop standards for optimal patient care," Dr. Carl L. Tommaso, chair of the document writing committee, said in a statement. "TAVR is a complex procedure that has the potential to serve many patients, and it is up to us to deliver the highest standards of care available," added Dr. Tommaso, medical director of the cardiac catheterization lab at Skokie Hospital, NorthShore HealthSystem, Chicago.
The 48-page document, prepared jointly by the American College of Cardiology Foundation, the Society for Cardiovascular Angiography and Interventions, the American Association for Thoracic Surgery, and the Society of Thoracic Surgeons, defines operator and institutional requirements for performing the procedure, and emphasizes the presence of multidisciplinary teams, which go beyond the collaboration between interventional cardiologists and cardiac surgeons.
"A TAVR program that uses only one specialty is fundamentally deficient, and valve therapy programs should not be established without this multidisciplinary partnership," the authors write.
The document also recommends that irrespective of their specialty, physicians in TAVR programs should all have extensive knowledge of valvular heart disease, and they should be able to interpret images.
Meanwhile, facilities should contain a full range of diagnostic imaging, in addition to an active valvular heart disease surgical program and "at least two institutionally-based cardiac surgeons experienced in valvular surgery," according to the document.
The role of an invested hospital administration is also emphasized.
"There must be dedication on the part of the hospital to provide these services and support, both financially and with no time constraints on the personnel involved," the authors write.
While they lay out minimum case number requirements for surgeons and interventionalists, the authors predict that simulators are "likely to play a significant role in technical training and proficiency maintenance for these evolving procedures," and the training strategy will evolve as the procedure becomes mainstream.
TAVR, which was approved in the United States in November 2011, is still in its infancy, so due to lack of data, many of the recommendations are based on expert consensus, according to the document.
Therefore, there "is the need for this to be a dynamic document that we will revisit in the future as the technology evolves, experience grows, and data accumulate," Dr. R. Morton Bolman, cochair of the document writing committee and chief of cardiac surgery at Harvard University, said in a statement.
Dr. Tommaso and Dr. Bolman had no relevant disclosures.