Multidisciplinary, team approach benefits TAVR patients

Nearly five years have passed since the Centers for Medicare & Medicaid Services (CMS) issued a national coverage determination for transcatheter aortic valve replacement (TAVR). During that time, the use of TAVR in patients with severe aortic stenosis and the number of FDA-approved TAVR devices have significantly increased. 

TAVR has not only been a practice-changing procedure in cardiology. It also serves as an example of how collaboration can benefit patients and providers alike.

A recent survey from the Society of Thoracic Surgeons (STS) found that 77.5 percent of cardiac surgeons were involved in TAVR procedures as part of multidisciplinary heart teams.

“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, from Houston Methodist Hospital, said in a news release. “We have a proven proof of principle that the team concept works and works well.”

STS sent the survey in June 2016 to surgeons who were part of its adult cardiac surgery database. The organization received completed surveys from 487 surgeons for a response rate of 18.8 percent.

The survey found that the cardiology and cardiac surgery divisions or departments jointly administered 58 percent of TAVR programs and the cardiac surgery department solely administered 15.3 percent of TAVR programs.

More than half of surgeons said they took part in every facet of the intraoperative procedure except for operating the imaging equipment. In addition, 82.1 percent of surgeons said they were involved in multidisciplinary meetings to discuss potential TAVR patients and 86.6 percent said they continued to care for TAVR patients following their procedures.

The researchers noted that multidisciplinary teams are the standard of care in oncology and transplantation for patients with complex clinical problems. With such an approach, the team members make joint decisions and consider the benefits and risks of all treatment options.

“This shared decision making ensures a decision that is patient-focused rather than therapist-biased,” they wrote. “All members of the team have a contemporaneous opportunity to evaluate, educate, and advise the patient about the treatment and options.”

Still, a multidisciplinary, team approach was not as common in cardiac care as it was for other specialties, according to the researchers. With TAVR, though, CMS requires a heart team approach for Medicare patients if centers want to receive reimbursement.

Based on the STS survey results, the heart team approach is common for most TAVR patients. Surgeons play a major role, as well.

“We believe that this multidisciplinary approach systematizes and optimizes the entire process of patient care,” the researchers wrote. “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.”