The American College of Cardiology (ACC), the American Association for Thoracic Surgery, the Society for Cardiovascular Angiography and Interventions, and The Society of Thoracic Surgeons have published a joint document on using transcatheter therapies to manage mitral regurgitation. The new document examines the responsible dissemination of these transcatheter therapies—specifically, it discusses the technologies’ critical components, operator training, protocols for care, and assessment of outcomes.
The Transcatheter Therapies for Mitral Regurgitation Societal Overview examines both the talent and technology necessary for successful transcatheter mitral regurgitation therapies. Citing the landmark SYNTAX trial, the authors note that the Heart Team is crucial. They also state that transcatheter mitral regurgitation therapies should be performed only at regional heart centres that have a high volume of heart valve procedures. As patient outcomes vary inversely with operator volume, the societies suggested that new transcatheter mitral regurgitation devices should only be available to high-volume centres that have met national criteria.
Discussing care protocols, the overview states that specific protocols for pre-, intra-, and post-procedural patient assessment and care should be put in place, as well as strategies to manage complications. Evaluation should include assessment of mitral valve anatomy and function, cardiac chamber sizes, biventricular function, pulmonary artery pressures, and any concomitant aortic or tricuspid valve pathology. Care protocols should include “clear delineation” of the various roles of the Heart Team members. In addition, patients should be transferred post-procedurally to a specialised cardiac/surgical intensive care unit, where the team can provide optimal and coordinated care.
“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,” said John H Calhoon, professor and Chair of Cardiothoracic Surgery at The University of Texas Health Science Center at San Antonio, USA, and overview Co-chair. “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.”
The full paper will publish online on the websites of the ACC, AATS, SCAI and STS. It will also be published in future print issues of The Journal of the American College of Cardiology; Journal of Thoracic and Cardiovascular Surgery, the journal for the American Association for Thoracic Surgery; Catheterization and Cardiovascular Interventions (CCI), the journal of The Society for Cardiovascular Angiography and Interventions; and The Annals of Thoracic Surgery, the journal of The Society of Thoracic Surgeons.