2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons

Published on May 28, 2019in Journal of the American College of Cardiology20.589
· DOI :10.1016/J.JACC.2018.10.007
Rick A. Nishimura128
Estimated H-index: 128
Patrick T. O'Gara86
Estimated H-index: 86
+ 11 AuthorsThoralf M. Sundt128
Estimated H-index: 128
This statement was commissioned as a Multisociety Expert Consensus Systems of Care Document by the American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), American Society of Echocardiography (ASE), Society for Cardiovascular Angiography and Interventions (SCAI), and
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This multisocietal Expert Consensus Systems of Care document was commissioned by the American Association for Thoracic Surgery (AATS), the American College of Cardiology (ACC), the Society for Cardiovascular Angiography and Interventions (SCAI), and the Society of Thoracic Surgeons (STS). Expert
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Aims: The number of transcatheter aortic valve implantation (TAVI) procedures is rapidly increasing. This has a major impact on health care resource planning. However, the annual numbers of TAVI candidates per country are unknown. The aim of this study was to estimate current and future number of annual TAVI candidates in 27 European countries, the USA and Canada. Methods and results: Systematic literature searches and meta-analyses were performed on aortic stenosis (AS) epidemiology and decisio...
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#1Clifford J. Kavinsky (Rush University Medical Center)H-Index: 22
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Catheter-based therapies for congenital and structural heart diseases (SHDs) have come a long way since the pioneering work of Terry King in 1976 with the first percutaneous atrial septal defect closure, the first mitral balloon valvuloplasty by Kanji Inoue in 1984, and the first percutaneous valve replacements by Philipp Bonhoeffer and Alain Cribier in the early 2000s. More than 100 000 transcatheter aortic valve replacements (TAVRs) have been performed in the United States, and the yearly numb...
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#1Vinay Badhwar (WVU: West Virginia University)H-Index: 31
#2J. Scott Rankin (WVU: West Virginia University)H-Index: 42
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The Society of Thoracic Surgeons Adult Cardiac Database (ACSD) is an international voluntary registry that provides adult cardiac surgery programs with risk-adjusted outcome reports for quality improvement. With more than 6,300,000 procedural records in adult cardiac surgery, the ACSD has proven to be a leading instrument for clinical outcomes research. The ACSD generated numerous major original contributions that were either published or accepted for publication in 2017. These works significant...
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Aims: To assess the knowledge and application of European Society of Cardiology (ESC) Guidelines in the management of mitral regurgitation (MR). Methods and results: A mixed-methods educational needs assessment was performed. Following a qualitative phase (interviews), an online survey was undertaken using three case scenarios (asymptomatic severe primary MR, symptomatic severe primary MR in the elderly, and severe secondary MR) in 115 primary care physicians (PCPs), and 439 cardiologists or car...
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Summary Background Mitral regurgitation is the most common valve disease worldwide but whether the community-wide prevalence, poor patient outcomes, and low rates of surgical treatment justify costly development of new therapeutic interventions remains uncertain. Therefore, we did an observational cohort study to assess the clinical characteristics, outcomes, and degree of undertreatment of mitral regurgitation in a community setting. Methods We used data from Mayo Clinic electronic health recor...
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Importance Identifying high-performing surgical valve centers with the best surgical outcomes is challenging. Hospital surgical volume is a frequently used surrogate for outcomes. However, its ability to distinguish low-performing and high-performing hospitals remains unknown. Objective To examine the association of hospital procedure volume with hospital performance for aortic and mitral valve (MV) surgical procedures. Design, Setting, and Participants Within an all-payer nationally representat...
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Risk aversion is a potential unintended consequence of health care public reporting. In Part 1 of this review, four possible consequences of this phenomenon are discussed, including the denial of interventions to some high-risk patients, stifling of innovation, appropriate avoidance of futile interventions, and better matching of high-risk patients to more capable providers. We also summarize relevant observational clinical reports and survey results from cardiovascular medicine and surgery, the...
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Part 1 of this review summarizes the consequences of risk aversion and the observational studies and surveys relevant to this phenomenon, almost all of which are derived from cardiac surgery and interventional cardiology. In Part 2, we describe the root cause of risk aversion—the belief by providers that current risk adjustment is inadequate to account for the severity of their highest-risk patients, thereby prejudicing their publicly reported performance scores. Evidence supporting the robustne...
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Abstract Mitral regurgitation (MR) is a complex valve lesion that can pose significant management challenges for the cardiovascular clinician. This Expert Consensus Document emphasizes that recognition of MR should prompt an assessment of its etiology, mechanism, and severity, as well as indications for treatment. A structured approach to evaluation based on clinical findings, precise echocardiographic imaging, and when necessary, adjunctive testing, can help clarify decision making. Treatment g...
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Structural heart disease (SHD) emergencies include acute deterioration of a stable lesion or development of a new critical lesion. Structural heart disease emergencies can produce heart failure and cardiogenic shock despite preserved systolic function that may not respond to standard medical therapy and typically necessitate surgical or percutaneous intervention. Comprehensive Doppler echocardiography is the initial diagnostic modality of choice to determine the cause and severity of the underly...
The disadvantages of mitral valve replacement with a bioprosthesis in the long-term may not play an important role if the shorter life expectancy of older patients is taken into account. This study aims to evaluate whether mitral valve replacement in the elderly is associated with similar outcome compared to repair in the short- and long-term. All patients aged 70 years and older undergoing minimally invasive mitral valve surgery were studied retrospectively. Primary outcome was 30-day complicat...
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Background Suprasternal access is an alternative access strategy for transcatheter aortic valve replacement (TAVR) where the innominate artery is cannulated from an incision above the sternal notch...
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The expert Position Statement is a description of the requirements for Accreditation for transcatheter mitral valve therapy (TMVT) in Australia. The requirements include the need for a multidisciplinary Heart Team review of individual cases, mandatory reporting of outcome data to a national TMVT Registry, and accreditation of individuals and institutions by the Conjoint Accreditation Committee, the assigned accreditation authority.
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The clinical relevance of as well as the optimal treatment strategy for coronary artery disease (CAD) in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS) are unclear. Current data are conflicting, and mainly derived from high-risk patients. We aimed to investigate the feasibility and safety of complete revascularization prior to TAVR for severe AS in low- and intermediate-risk patients. We enrolled 449 patients at low (STS score null 3 months) com...
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Abstract null null This series reports the safety and feasibility of MitraClip (Abbott Vascular) in 7 high surgical risk Indian patients with symptomatic mitral regurgitation (MR). The clip was deployed successfully in all patients, and more than one clip was required in 5. All had reduction in MR to ≤2+. Mean mitral valve gradient was 3.0 ± 0.8 mmHg. At 12 months follow up, all were alive, and the MR grade was 1+ in 6 patients and 2+ in one. Mean MV gradient was 3.4 ± 1.0 mmHg. The modified Kan...