Brijeshwar Maini, MD, FACC, structural heart cardiologist, national and Florida medical director of cardiology, Tenant Health, explains what hospitals need to build a structural heart program and develop a heart-team care collaboration approach. He spoke with Cardiovascular Business at the 2022 Transcatheter Valve Therapeutics (TVT) Structural Heart Summit.
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.
Related Heart Team and Creating Structural Heart Program Content:
VIDEO: How to build a structural heart program — Interview with Charles Davidson, MD
VIDEO: Creating an integrated heart team program in central Texas — Interview with Charles D. Fraser, Jr., MD
Heart Team consultations lead to better patient outcomes, fewer unexpected hospitalizations
VIDEO: The state of TAVR in 2022 — Michael Mack, MD, said heart teams are the real legacy of TAVR
TAVR's success has changed how cardiologists and surgeons view aortic valve replacement
Cardiac surgeons gaining procedural volume despite TAVR making up 84% of cases
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com