78% of cardiothoracic surgeons perform TAVR procedures as part of team

More than three-quarters of cardiothoracic surgeons performed transcatheter aortic valve replacement (TAVR) procedures as part of a heart team, according to a Society of Thoracic Surgeons (STS) survey.

Lead researcher Joseph E. Bavaria, MD, of the University of Pennsylvania, and colleagues published their results online in The Annals of Thoracic Surgery on April 10.

The researchers mentioned that TAVR has become more common since CMS issued a national coverage determination in May 2012 that allowed the coverage of TAVR under certain conditions. The FDA has also approved TAVR devices for certain patients with severe aortic stenosis.

In June 2016, the researchers sent the survey via email to 2,594 surgeons who were part of the STS adult cardiac surgery database. A total of 487 surgeons responded within the two-week cutoff period for a response rate of 18.8 percent.

Of the respondents, 77.5 percent said they performed TAVR procedures as part of the heart team. In addition, 84 percent said that TAVR was performed at their institutions, while 58 percent said the cardiology and cardiac surgery divisions administered the programs and 15.3 percent said the cardiac surgery department administered the program.

“I was surprised but pleased to see that a majority of patients were managed by some sort of combination of cardiac surgeons and cardiologists,” Bavaria said in a news release. “I didn’t expect it to be such a team effort.”

Cardiologists and cardiac surgeons referred potential TAVR patients to the heart team at 83.7 percent of the programs and scheduled regular, multidisciplinary meetings to discuss potential TAVR patients at 91.4 percent of the programs. Cardiac surgeons took place in 82.1 percent of the meetings.

The survey found that 89 percent of surgeons were responsible for obtaining alternative access routes, 70.8 percent obtained femoral artery access, 85 percent performed open repair of femoral vessels when needed and more than half took part in every facet of the intraoperative procedure except for operating the imaging equipment. In addition, 86.6 percent of surgeons continued to participate in patients’ care after the TAVR procedures.

Of the surgeons who regularly performed TAVR, 40.5 percent performed five to nine procedures per month, 11.8 percent performed 10 to 14 cases per month, 6.5 percent performed 15 to 19 procedures per month and 5.2 percent performed 20 or more cases per month.

“Not only are cardiac surgeons actively participating during the preoperative and intraoperative phases of TAVR, but they also are involved in the postoperative care of TAVR patients,” STS Treasurer Thomas E. MacGillivray, MD, of Houston Methodist Hospital, said in a news release. “We have a proven proof of principle that the team concept works and works well.”

The survey had a few limitations, according to the researchers, including that they only sent it electronically and only sent one reminder. However, they said that 487 responses provided a good representative sample of the 471 sites that participated in the STS/American College of Cardiology transcatheter valve therapy registry.

“The heart team model for TAVR works and works well,” the researchers wrote. “We believe that this multidisciplinary approach systematizes and optimizes the entire process of patient care. Through shared decision making and joint procedural execution, all members of the team can bring to the patient their experience and expertise. As a result, the right procedure can be performed on the right patient by the right doctor(s) at the right time and in the right way, thereby maximizing the likelihood of success while helping to ensure patient safety. The next logical step of the TAVR heart team model is to extend this highly successful paradigm to other aspects of cardiac care.”