Consensus Recommendations and Requirements for Transcatheter Mitral Valve Intervention

Members of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons published a consensus system of care document containing operator and institutional recommendations and requirements for transcatheter mitral valve interventions, which was published in the Journal of the American College of Cardiology.

The committee members recommend that sites use methods and processes that support both patient- and family-centered care with informed and shared decision making. Family members and patients should not only receive education regarding the procedure, but be informed of potential risks and benefits associated with transcatheter mitral valve intervention. An individual risk assessment approach based on the patient’s unique needs and risk profile should be conducted prior to the intervention.

In addition, the committee recommends a collaborative multidisciplinary team approach to care for patients undergoing transcatheter mitral valve intervention, including experts in heart failure, cardiac imaging, cardiac valve surgery, nursing, cardiac anesthesia, and interventional cardiology. The document also emphasizes the necessity for practitioners to acquire skills to perform transcatheter mitral valve interventions via trans-septal and transapical access.

The committee also highlights the new expanded indication for edge-to-edge transcatheter mitral valve repair, which now includes secondary mitral regurgitation. They also recommend that studies on transcatheter mitral valve intervention include the following outcomes: in-hospital and 30-day mortality, 30-day stroke/transient ischemic stroke, 30-day major vascular complication, 30-day major bleeding, 30-day moderate or severe mitral regurgitation, 30-day significant mitral stenosis, and 1-year all-cause mortality.

In addition, it is recommended that in sites initiating transcatheter mitral valve interventions interventionalists document 50 lifetime structural heart procedures, prior experience with transcatheter mitral valve repair with 20 trans-septal access per lifetime, and device-specific training certification in an effort to optimize outcomes. Programs currently performing transcatheter mitral valve repairs should document >20 interventions per year or >40 interventions over the prior 2 years, as well as >20 mitral valve surgeries per year or >40 surgeries over 2 years.

 “[T]he guiding principles and foundational elements included in this and companion multisociety documents constitute an enduring commitment to optimizing patient outcomes,” noted the guideline authors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Bonow RO, O’Gara PT, Adams DH, et al. 2019 AATS/ACC/SCAI/STS expert consensus systems of care document: operator and institutional recommendations and requirements for transcatheter mitral valve intervention: a joint report of the American Association for Thoracic Surgery, the American College of Cardiology, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons [published online December 16, 2019]. J Am Coll Cardiol. doi:10.1016/j.jacc.2019.12.002