Maini was a pioneer in the heart team approach with the development of transcatheter aortic valve replacement (TAVR) a decade ago. This model included the interventional cardiologist, cardiac surgeon, interventional sonographer, cardiac imager or radiologist, nursing, patient navigator and other support staff so everyone is on the same page and has a say in selecting patients for transcatheter structural heart procedures and which would be betters served by open heart surgery. They also collaborate in regular heart team meetings to follow the patient through screening, pre-procedural evaluation, procedure and post-procedural recovery and followup.
Beyond the heart team, he said there are many other considerations.
Patient navigators of nurses who field calls from patients are also extremely important in these programs Maini explained.
"They are our liaison between us, our referring cardiologist and our patients," Maini said. "They are the go-in-between. These patients have multiple questions, but busy physicians, cardiologists and surgeons, do not have the time to call 50 patients on a daily basis. Not that we should not, but there are only 24 hours in a day."
He also explains how the partnership between surgeons and interventional cardiologists has actually helped boost the number of cardiac surgeries. Several centers Cardiovascular Business has spoke with in 2022 have seen increases in cardiac surgical volumes, despite TAVR now accounting for 84% of aortic valve replacements. This is because of a new mind-set that TAVR pro idea, where less sick patients are now seeking care, including younger patients who are better served by surgery. A surgical replacement now will enable use of TAVR years later when the first valve wears out, Maini said.
In the past, he said many patients, especially older ones, were told the risk if surgery was not worth it, but with a minimally invasive approach, this has greatly broadened patient volumes.
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