Preamble
1. Introduction
1.1 Background
- Vahanian A.
- Alfieri O.
- Andreotti F.
- et al.
1.2 Statement of the Problem
1.3 Purpose of the Document
- Nishimura R.A.
- Otto C.M.
- Bonow R.O.
- et al.

1.4 Elements of the Model
- Vahanian A.
- Alfieri O.
- Andreotti F.
- et al.
2. Methods
- Otto C.M.
- Kumbhani D.J.
- Alexander K.P.
- et al.
- Bonow R.O.
- Brown A.S.
- et al.
ACC/AATS/AHA/ASE/EACTS/HVS/SCA/SCAI/SCCT/SCMR/STS 2017 appropriate use criteria for the treatment of patients with severe aortic stenosis: a report of the American College of Cardiology Appropriate Use Criteria Task Force, American Association for Thoracic Surgery, American Heart Association, American Society of Echocardiography, European Association for Cardio–Thoracic Surgery, Heart Valve Society, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, Society for Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.
- Bavaria J.E.
- Tommaso C.L.
- Brindis R.G.
- et al.
3. Historical Perspective From Other Programs
Cancer | Trauma | Stroke | Bariatric surgery | STEMI | |
---|---|---|---|---|---|
Year initiated | 1960 | 1976 | 2001 | 2005 | 2006/2007 |
Sponsoring organization | National Institutes of Health | American College of Surgeons | Brain Attack Coalition | American Society of Bariatric Surgery American College of Surgeons | American College of Cardiology (D2B Alliance) American Heart Association (Mission: Lifeline) |
Levels of care | Basic Laboratory Cancer Center Cancer Centers Comprehensive Cancer Center | Level I Level II Level III Level IV | Acute Stroke-Ready hospital Primary Stroke Center Comprehensive Stroke Center | Bariatric Surgery Center of Excellence | STEMI-referral hospital (non-PCI capable) STEMI-receiving hospital (PCI-capable) |
- Bavaria J.E.
- Tommaso C.L.
- Brindis R.G.
- et al.
4. Proposed Structure for an Integrated Model of Care for Patients With VHD
4.1 Underlying Principles
- •The primary goal is to improve the care of all patients with VHD.
- •The first step is recognition and subsequent diagnosis of VHD, usually by a primary care physician, advanced practice provider, or general cardiologist.
- •The second step often involves referral to a local general cardiologist who can further refine the diagnosis, initiate medical therapy as indicated, and identify those who can be managed for the time being without further intervention or who may need more specialized care such as surgery or transcatheter valve repair or replacement.
- •Access to specialized care requires establishment of well-defined referral lines to centers having graduated levels of expertise and resources (Figure 1). Increasing disease complexity often requires higher-order, comprehensive care at a Level I center, whereas less complex disease can be managed at a Level II center.
- •A Multidisciplinary Team (MDT) and an emphasis on patient shared decision-making are essential to the operations of both Level I and II valve centers.
- •Full institutional support is required for provision of appropriate imaging and procedural resources, equity among the individual stakeholders of the MDT, care pathways that span the continuum, registry participation, and results reporting.
- •Transparency, public reporting, mandatory participation in national registries, ongoing analysis of processes and outcomes, and a commitment to research are essential.
- •Bidirectional communication and ongoing education of members of the MDT and the community of referring providers/centers are required to improve the quality of care in all settings.
- •Processes of care should emphasize informed consent (information provided in various formats and languages), SDM, patient experiences, and individual choices.
4.2 Role of the Primary Care Clinician
- Douglas P.S.
- Garcia M.J.
- Haines D.E.
- et al.
4.3 Comprehensive (Level I) and Primary (Level II) Valve Centers
5. Structure
5.1 Structural Requirements of All Advanced Valve Centers
Comprehensive (Level I) valve center | Primary (Level II) valve center |
---|---|
Interventional procedures | |
TAVR–transfemoral | TAVR–transfemoral |
Percutaneous aortic valve balloon dilation | Percutaneous aortic valve balloon dilation |
TAVR–alternative access, including transthoracic (transaortic, transapical) and extrathoracic (eg, subclavian, carotid, caval) approaches | |
Valve-in-valve procedures | |
Transcatheter edge-to-edge mitral valve repair | |
Paravalvular leak closure | |
Percutaneous mitral balloon commissurotomy | |
Surgical procedures | |
SAVR | SAVR |
Valve-sparing aortic root procedures | |
Aortic root procedures for aneurysmal disease | |
Concomitant septal myectomy with AVR | |
Root enlargement with AVR | |
Mitral repair for primary MR | Mitral repair for posterior leaflet primary MR |
Mitral valve replacement | Mitral valve replacement |
Multivalve operations | |
Reoperative valve surgery | |
Isolated or concomitant tricuspid valve repair or replacement | Concomitant tricuspid valve repair or replacement with mitral surgery |
Imaging personnel | |
Echocardiographer with expertise in valve disease and transcatheter and surgical interventions | Echocardiographer with expertise in valve disease and transcatheter and surgical interventions |
Expertise in CT with application to valve assessment and procedural planning | Expertise in CT with application to valve assessment and procedural planning |
Interventional echocardiographer to provide imaging guidance for transcatheter and intraoperative procedures 53 | |
Expertise in cardiac MRI with application to assessment of VHD | |
Criteria for imaging personnel | |
A formalized role/position for a “valve echocardiographer” who performs both the pre- and postprocedural assessment of valve disease | A formalized role/position for a “valve echocardiographer” who performs both the pre- and postprocedural assessment of valve disease |
A formalized role/position for the expert in CT who oversees the preprocedural assessment of patients with valve disease | A formalized role/position for the expert in CT who oversees the preprocedural assessment of patients with valve disease |
A formalized role/position for an interventional echocardiographer | |
Institutional facilities and infrastructure | |
MDT (Table 3) | MDT (Table 3) |
A formalized role/position for a dedicated valve coordinator who organizes care across the continuum and system of care | A formalized role/position for a dedicated valve coordinator who organizes care across the continuum and system of care |
Cardiac anesthesia support | Cardiac anesthesia support |
Palliative care team | Palliative care team |
Vascular surgery support | Vascular surgery support |
Neurology stroke team | Neurology stroke team |
Consultative services with other cardiovascular subspecialties (see Section 5.2.4 Personnel, Institutional Facilities, and Infrastructure) | |
Consultative services with other medical and surgical subspecialties (see Section 5.2.4 Personnel, Institutional Facilities, and Infrastructure) | |
Echocardiography–3D TEE; comprehensive TTE for assessment of valve disease | Echocardiography–comprehensive TTE for assessment of valve disease |
Cardiac CT | Cardiac CT |
ICU | ICU |
Temporary mechanical support (including percutaneous support devices such as intra-aortic balloon counterpulsation, temporary percutaneous ventricular assist device or ECMO) | Temporary mechanical support (including percutaneous support devices such as intra-aortic balloon counterpulsation, temporary percutaneous ventricular assist device or ECMO) |
Left/right ventricular assist device capabilities (on-site or at an affiliated institution) | |
Cardiac catheterization laboratory, hybrid catheterization laboratory, or hybrid OR laboratory | Cardiac catheterization laboratory |
PPM and ICD implantation | PPM and ICD implantation |
Criteria for institutional facilities and infrastructure | |
IAC echocardiography laboratory accreditation | IAC echocardiography laboratory accreditation |
24/7 intensivist coverage for ICU |
Left atrial appendage closure |
ASD or VSD closure |
Alcohol septal ablation |
Mitral valve replacement, mitral valve repair with techniques other than edge-to-edge clip system (currently investigational devices) |
Tricuspid valve repair |
Pulmonary balloon valvotomy or valve replacement |
5.2 Structural Components of Advanced Valve Centers
5.2.1 Transcatheter treatments
5.2.2 Cardiac surgical procedures
5.2.3 Imaging
5.2.4 Personnel, institutional facilities, and infrastructure
|
6. Process
6.1 Process Requirements for Advanced Heart Valve Centers
Comprehensive (Level I) valve centers | Primary (Level II) valve centers |
---|---|
Documentation of formal referral and clinical pathways across the continuum of care | |
Documentation of communication pathways among Level I, Level II, and practice-level providers | |
Multidisciplinary team | |
All patients are evaluated by the MDT | All patients are evaluated by the MDT |
The MDT educates patients regarding treatment recommendations, treatment options, and the use of an SDM process that incorporates patient preferences. | The MDT educates patients regarding treatment recommendations, treatment options, and the use of an SDM process that incorporates patient preferences. |
The MDT meets on a regular basis (preferably each week) to review cases, reach consensus management decisions, review outcomes, and assess quality. | The MDT meets on a regular basis (preferably each week) to review cases, reach consensus management decisions, review outcomes, and assess quality. |
Criteria/metrics | |
Documentation of attendance at MDT meetings and recording of the discussion and decision-making process for cases presented | Documentation of attendance at MDT meetings and recording of the discussion and decision-making process for cases presented |
Documentation of an action plan to address performance and quality areas needing improvement | Documentation of an action plan to address performance and quality areas needing improvement |
Regular morbidity and mortality meetings | Regular morbidity and mortality meetings |
Registry participation | |
Participation in the STS/ACC TVT registry or other accepted national registries | Participation in the STS/ACC TVT registry or other accepted national registries |
Participation in the STS ACSD or other approved surgical database | Participation in the STS ACSD or other approved surgical database |
Criteria/metrics | |
TVT registry
| TVT registry
|
National surgical database participation that meets state requirements | National surgical database participation that meets state requirements |
Surgical performance that meets STS 2- or 3-star rating criteria | Surgical performance that meets STS 2 or 3 star rating criteria |
Research | |
Participation in pivotal RCTs comparing devices or device with surgery (optional) | |
Publication of single-center or multicenter patient outcome studies (optional) | |
Education and shared decision making | |
Continuing education of MDT members | Continuing education of MDT members |
Education of patients and the public | Education of patients and the public |
Documentation of participation with patients in SDM using objective and validated resources and decision aids | Documentation of participation with patients in SDM using objective and validated resources and decision aids |
Training | |
Structural interventional fellowship year (optional) | |
Cardiac surgery training in interventional structural heart skills and procedures (optional) | |
Advanced training in echocardiography cardiac CT and CMR for the evaluation of VHD and guidance of valve procedures (optional) |
6.2 Process Components for Advanced Heart Valve Centers
6.2.1 Function of the MDT
AHRQ. The SHARE Approach. Available at: https://www.ahrq.gov/professionals/education/curriculum-tools/shareddecisionmaking/index.html. Accessed July 30, 2018.
6.2.2 Registry participation
6.2.3 Research
6.2.4 Education
6.2.5 Training
7. Performance Metrics
7.1 Assessment of Quality of Care and Development of Performance Metrics for VHD Centers
- 1.To provide patients and referring physicians with experience and results achieved at individual valve centers;
- 2.To promote the highest-quality standards for the care of patients with VHD; and
- 3.To establish a mechanism for every center to have a process for self-examination, and to improve continuously by using objective data that are benchmarked against national standards reported through professional society registries.

- Bavaria J.E.
- Tommaso C.L.
- Brindis R.G.
- et al.
7.1.1 TAVR
- Bavaria J.E.
- Tommaso C.L.
- Brindis R.G.
- et al.
2018 Criteria | |
---|---|
Primary outcome metrics | Performance requirement |
In-hospital risk-adjusted all-cause mortality |
|
30-day risk-adjusted all-cause mortality |
|
30-day all-cause neurological events, including TIAs |
|
30-day major vascular complications |
|
30-day major bleeding |
|
30-day moderate or severe AR |
|
Primary outcome metrics in development | |
1-year risk adjusted all-cause mortality | |
Patient-reported health status (KCCQ) at 30 days and 1 year versus baseline | |
30-day and 1-year risk-adjusted mortality and morbidity (composite index) |
- Bavaria J.E.
- Tommaso C.L.
- Brindis R.G.
- et al.
TAVR quality requirements |
---|
To have optimal outcomes, a program will have:
|
SAVR quality requirements |
To have optimal outcomes, a program will have:
|
7.1.2 Surgical mitral valve repair
- Vahanian A.
- Alfieri O.
- Andreotti F.
- et al.
To optimize outcomes, a mitral program will have:
|
Threshold for moderate or high volume:
|
7.2 Public Reporting
8. Obstacles and Challenges to a VHD System of Care
- 1.Access. The writing committee acknowledges that many patients may not be able or wish to travel to a remote center for VHD care for reasons related to age, frailty, geographic distance, separation from family, trust in their local caregivers, and the uncertainty created by placing their care in the hands of unfamiliar clinicians. There are additional barriers related to health plan coverage, restricted referral networks, lack of interoperability for both healthcare records and imaging, and perceptions of cultural bias. Many of these barriers have been addressed by large, vertically aligned healthcare systems in which cardiovascular specialists are employed and resources have already been consolidated to enhance efficiency. Referral out of network for other patients, however, may simply not be possible in part because of the economic environment that characterizes the current U.S. healthcare environment. In addition, some would argue that separation of patients from their local communities negates the possibility of achieving SDM. Patient preferences should always be respected, but an informed discussion of all treatment options available and the outcomes to be expected (as publicly reported), is an important prerequisite for successful SDM. Education, communication, and transparency can address some but not all of these issues. Cultural barriers to access involve more than simple geography and require interventions that are beyond the scope of this document. Whereas supporting a primary (Level II) valve center in a geographically remote/rural area is feasible on a selective basis, expanding the number of valve centers in metropolitan areas already populated by several programs is more difficult to rationalize.
- 2.Communication. The interoperability of electronic health records and digital imaging data needed to enable seamless patient movement within a VHD system of care is not available even within some vertically integrated health systems.
- 3.Cost. Comprehensive (Level I) Valve Centers will experience the higher costs associated with the management of more complex and higher-risk patients undergoing more expensive care with longer stays. Start-up and maintenance costs to establish and sustain the infrastructure required to provide comprehensive care for complex patients are substantial. Patients and families may incur higher costs related to travel or out-of-network care.
- 4.Professional and institutional skepticism. The writing committee also acknowledges that the simple construct of a tiered system of care may create the perception that this proposal would perpetuate the dominance of larger centers at the expense of smaller centers. The proposed concept of a system of care for VHD patients is not conceived to deny individuals and institutions the opportunity to provide services, nor should it be perceived to impede the ability of a committed center to achieve its strategic goals. Rather, it is intended to focus more on outcomes and not simply on procedural volumes, while providing a platform to guide best practices and promote quality improvement across all centers interested in the care of patients with VHD. Additionally, the proposal is not TAVR-specific but rather is meant to highlight the range of services, expertise, and experience required to care for patients across the spectrum of VHD. Health services research to assess the impact of a tiered system of care on patient outcomes, quality, and cost must be supported.
- 5.Knowledge and performance gaps. As discussed throughout this document, these persist despite the collective efforts of institutions, health systems, and professional societies. Enhanced collaboration and more targeted educational efforts are needed to reduce the observed variability in care and outcomes.
9. Summary and Next Steps
The Joint Commission. Comprehensive Cardiac Center Advanced Certification Program. Available at: https://www.jointcommission.org/approved_comprehensive_cardiac_center/. Accessed March 12, 2017.
Presidents and Staff
Appendix 1. Abbreviations
ACC | American College of Cardiology |
AATS | American Association for Thoracic Surgery |
AS | aortic stenosis |
ASE | American Society of Echocardiography |
AVR | aortic valve replacement |
CT | computed tomography |
KCCQ | Kansas City Cardiomyopathy Questionnaire |
LV | left ventricular |
MDT | multidisciplinary team |
MR | mitral regurgitation |
SAVR | surgical aortic valve replacement |
SCAI | Society for Cardiovascular Angiography and Interventions |
SDM | shared decision making |
STEMI | ST-segment elevation myocardial infarction |
STS | Society of Thoracic Surgeons |
STS ACSD | Society of Thoracic Surgeons Adult Cardiac Surgery Database |
TAVR | transcatheter aortic valve replacement |
VHD | valvular heart disease |
Appendix 2. Author Relationships With Industry and Other Entities (Relevant)—2018 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease
Committee member | Employment | Consultant | Speakers bureau | Ownership/partnership/principal | Personal research | Institutional, organizational, or other financial benefit | Expert witness |
---|---|---|---|---|---|---|---|
Rick A. Nishimura (Co-Chair) | Mayo Clinic, Division of Cardiovascular Disease—Judd and Mary Morris Leighton Professor of Medicine | None | None | None | None | None | None |
Patrick T. O’Gara (Co-Chair) | Harvard Medical School—Professor of Medicine; Brigham and Women’s Hospital Cardiovascular Division—Director, Clinical Cardiology | None | None | None | None | None | None |
Joseph E. Bavaria | Hospital of the University of Pennsylvania—Director, Thoracic Aortic Surgery Program | None | None | None | None | ||
Ralph G. Brindis | ACC National Cardiovascular Data Registry—Senior Medical Officer Philip R. Lee Institute for Health Policy Studies, UCSF—Clinical Professor | None | None | None | None | None | None |
John D. Carroll | University of Colorado Denver—Professor of Medicine; Director, Interventional Cardiology |
| None | None |
| None | |
Clifford J. Kavinsky | Rush University Medical Center—Professor of Medicine | None | None | None | None | None | None |
Brian R. Lindman | Vanderbilt University Medical Center—Associate Professor of Medicine; Medical Director, Structural Heart and Valve Center | Roche Diagnostics Medtronic | None | None | None | None | |
Jane A. Linderbaum | Mayo Clinic—Assistant Professor of Medicine; Associate Medical Editor for AskMayoExpert | None | None | None | None | None | None |
Stephen H. Little | Houston Methodist Hospital—Associate Professor; John S. Dunn Chair in Clinical Cardiovascular Research and Education | None | None | None | None | None | |
Michael J. Mack | Baylor Scott & White Health—Chair Cardiovascular Service Line | None | None | None | None | None | |
Laura Mauri | Harvard Medical School—Professor of Medicine; Brigham and Women’s Hospital Cardiovascular Division. Medtronic—Global VP of Clinical Research and Analytics | None | None | None | None | ||
William R. Miranda | Mayo Clinic—Cardiology Fellow, Instructor in Medicine | None | None | None | None | None | None |
David M. Shahian | Massachusetts General Hospital—VP Quality and Safety; Harvard Medical School—Professor of Surgery; Chair, STS Council on Quality, Research, and Patient Safety | None | None | None | None | None | None |
Thoralf M. Sundt, III | Massachusetts General Hospital—Chief, Division of Cardiac Surgery; Director, Corrigan Minehan Heart Center | None | None | None | None | None | None |
Appendix 3. Peer Reviewer Information—2018 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease
Reviewer | Representation | Employment |
---|---|---|
Frank V. Aguirre | Official Reviewer—BOG | Prairie Cardiovascular Consultants—Interventional Cardiologist |
Joanna Chikwe | Official Reviewer—AATS | The Icahn School of Medicine at Mount Sinai—Professor and Chief, Division of Cardiothoracic; Professor of Cardiovascular Surgery; Heart Institute, Stony Brook University Medical Center—Surgery Director |
Larry S. Dean | Official Reviewer—SCAI | University of Washington School of Medicine—Professor of Medicine and Surgery; UW Medicine Regional Heart Center—Director |
Joseph A. Dearani | Official Reviewer—STS | Mayo Clinic—Chair, Cardiovascular Surgery |
Daniel Engelman | Official Reviewer—AATS | Heart, Vascular & Critical Care Services Baystate Medical Center—Interim Chief, Division of Cardiac Surgery; Medical Director; University of Massachusetts Medical School-Baystate—Associate Professor of Surgery |
Judy W. Hung | Official Reviewer—ASE | Massachusetts General Hospital Cardiac—Associate Director, Echocardiography, Division of Cardiology |
Chad Kliger | Official Reviewer—SCAI | Lenox Hill Hospital—Director, Structural Heart Disease, Cardiovascular Medicine; Hofstra/Northwell—Assistant Professor, Donald and Barbara Zucker School of Medicine |
Leonard Y. Lee | Official Reviewer—AATS | Rutgers Robert Wood Johnson Medical School—Chairman |
Thomas E. MacGillivray | Official Reviewer—STS | DeBakey Heart & Vascular Center—Chief, Division of Cardiac Surgery & Thoracic Transplant Surgery |
Sunil V. Mankad | Official Reviewer—ASE | Mayo Clinic—Associate Professor of Medicine |
James K. Min | Official Reviewer—Task Force on Expert Consensus Decision Pathways | Dalio Institute of Cardiovascular Imaging at New York Presbyterian Hospital—Professor of Radiology and Medicine; Director |
Sandra V. Abramson | Organizational Reviewer—ACP | Lankenau Heart Pavilion—Medical Director, Cardiovascular Imaging Center; Director, Interventional Echocardiography |
Oluseun O. Alli | Organizational Reviewer—Novant Health | NOVANT Heart and Vascular Institute—Assistant Professor |
Mary Beth Brady | Organizational Reviewer—SCA | Johns Hopkins University School of Medicine—Vice Chair for Education, Department of Anesthesiology and Critical Care Medicine; Associate Professor, Anesthesiology and Critical Care Medicine |
Samjot Brar | Organizational Reviewer—Kaiser Permanente | Kaiser Permanente Los Angeles Medical Center and Kaiser Permanente Research—Interventional Cardiologist and Vascular Specialist; Chair, Regional Research Committee; The University of California, Los Angeles—Assistant Clinical Professor of Medicine |
Sameer A. Gafoor | Organizational Reviewer—Swedish Medical | University of Michigan Medical School—Associate Professor |
Brian B. Ghoshhajra | Organizational Reviewer—SCCT | Massachusetts General Hospital—Service Chief, Cardiovascular Imaging; Program Director, Cardiac Imaging Fellowship |
Rebecca T. Hahn | Organizational Reviewer—Columbia University College of Physicians and Surgeons | Columbia University College of Physicians and Surgeons—Associate Professor of Clinical Medicine |
Uzoma N. Ibebuogu | Organizational Reviewer—ABC | University of Tennessee Health Sciences Center—Associate Professor of Medicine, Division of Cardiovascular Diseases; Methodist University Hospital—Director of Structural Heart Disease Intervention |
Josh Rovin | Organizational Reviewer—Baycare/Morton Plant | Morton Plant Hospital—Director, Center for Advanced Valve and Structural Heart Care; Director of Transcatheter and Aortic Therapies |
Scott R. Shipman | Organizational Reviewer—AAMC | Association of American Medical Colleges—Director of Primary Care Affairs and Workforce Analysis |
Amy E. Simone | Organizational Reviewer—AAPA | Emory University Hospital Midtown—Physician Assistant, Department of Cardiothoracic Surgery Structural Heart & Valve Program |
Andrew Wang | Organizational Reviewer—AHA | Duke University Medical Center—Professor of Medicine; Director, Cardiovascular Disease Fellowship Program |
Puja Banka | Content Reviewer—Imaging Council | Boston Children's Hospital—Assistant Professor of Pediatrics |
Eric R. Bates | Content Reviewer—Individual Expert | University of Michigan—Professor of Medicine |
Blasé A. Carabello | Content Reviewer—Vascular Heart Disease Guideline Writing Committee | East Carolina Heart Institute at ECU—Professor and Chief, Division of Cardiology |
Michael S. Firstenberg | Content Reviewer—Surgeons’ Council | Northeast Ohio Medical Universities—Director, Adult ECMO Program; Director, Surgical Research; Associate Professor of Surgery and Integrative Medicine; Summa Akron City Hospital—Cardiothoracic Surgeon |
Linda D. Gillam | Content Reviewer—Health Affairs Committee | Morristown Medical Center—Chair, Department of Cardiovascular Medicine |
David R. Holmes, Jr. | Content Reviewer—ACC Roundtable Participant | Mayo Clinic—Professor of Medicine, Department of Cardiovascular Medicine |
Alexander Iribarne | Content Reviewer—Surgeons’ Council | Dartmouth Hitchcock Medical Center—Assistant Professor of Surgery |
Patricia Keegan | Content Reviewer—ACC Roundtable Participant | Emory Structural Heart and Valve Center—Structural Heart Coordinator |
Thomas M. Maddox | Content Reviewer—Task Force on Health Policy Statements and Systems of Care | Washington University School of Medicine/BJC Healthcare—Director, Health Systems Innovation Lab (HSIL); Washington University School of Medicine—Professor of Medicine (Cardiology) |
Elizabeth N. Perpetua | Content Reviewer—ACC Roundtable Participant | University of Washington Medical Center—Director, Structural Heart Services; Associate Director, Center for Cardiovascular Emerging Therapies; Teaching Associate, Cardiology and Cardiac Surgery |
Donnette Smith | Content Reviewer—ACC Roundtable Participant | Mended Hearts—President |
Carl L. Tommaso | Content Reviewer—TAVR Requirements Writing Committee Chair | NorthShore University Health System—Associate Director, Cardiac Catheterization Labs; Rush Medical College—Associate Professor of Medicine |
William A. Van Decker | Content Reviewer—Health Affairs Committee | Temple University Hospital—Assistant Professor of Medicine |
Gaby Weissman | Content Reviewer—Cardiovascular Training Council | Medstar Washington Hospital Center—Director, Cardiovascular Magnetic Resonance Imaging (MRI) Core Laboratory |
Frederick G. P. Welt | Content Reviewer—Interventional Council | University of Utah Health Sciences Center—Director, Interventional Cardiology |
Michael J. Wolk | Content Reviewer—Task Force on Health Policy Statements and Systems of Care | Weill Medical College of Cornell University—Clinical Professor of Medicine |
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This document was approved by the American Association for Thoracic Surgery (AATS) Council, American College of Cardiology (ACC) Clinical Policy Approval Committee, American Society for Echocardiography (ASE) Board of Directors, the Society for Cardiovascular Angiography and Interventions (SCAI) Board of Directors, and the Society of Thoracic Surgeons (STS) Board of Trustees in October 2018
The American Association for Thoracic Surgery requests that this document be cited as follows: Nishimura RA, O’Gara PT, Bavaria JE, Brindis RG, Carroll JD, Kavinsky CJ, Lindman BR, Linderbaum JA, Little SH, Mack MJ, Mauri L, Miranda WR, Shahian DM, Sundt TM III. 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. J Thorac Cardiovasc Surg. 2019;157:e327-54.
This article has been copublished in Catheterization and Cardiovascular Interventions, the Journal of the American Society of Echocardiography, the Journal of Thoracic and Cardiovascular Surgery, and the Annals of Thoracic Surgery.
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- Commentary: The devil is in the detailsThe Journal of Thoracic and Cardiovascular SurgeryVol. 157Issue 6
- PreviewRecognizing the rapidly changing landscape of interventional options for the treatment of valvular heart disease as well as significant gaps in care for patients with these conditions, representatives of the American College of Cardiology, under the auspices of their Task Force on Health Policy and Systems of Care, convened several years ago a multidisciplinary roundtable of cardiologists, imagers, advanced practitioners, surgeons, industry representatives government officials, and patient advocacy groups to discuss the challenges in the diagnosis and treatment of valvular heart disease in the United States.
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