VIDEO: How to build a structural heart program
Charles Davidson, MD, clinical chief of cardiology and medical director of the Bluhm Cardiovascular Institute, vice-chair for clinical affairs in the department of medicine, and professor of medicine, Northwestern University, explains what hospitals need to consider when starting a new structural heart program. He spoke with Cardiovascular Business at the 2022 Transcatheter Valve Therapeutics (TVT) Structural Heart Summit.
He explained the key elements required include:
1. Champion interventional cardiologists and cardiac surgeons who can work together as a team and share decision making for what is best for the patient.
2. Interventional imagers who can work as a key part of the team for pre-procedural evaluations and guide imaging during procedures. This is usually a dedicated interventional echocardiographer. Imagers who can review pre-planning CT for measurements and assessment of anatomy is also key.
3. The hospital will need to create a support team that includes nurses trained in TAVR, patient navigators and other support staff to coordinate scheduling and guide the patient through their care journey. This helps coordinate all the moving parts and frees up the physicians and other clinicians to concentrate on procedures and clinical decision making rather than the large amount of non-clinical work involved.
4. A hybrid cath lab that is rated for open surgical procedures is ideal. He said this is in case there is need for conversion to open procedures or surgical access for transapical or other alternative access routes. The larger rooms are also needed for the addition of extra staff and equipment for peri-procedural imaging, anesthesia and additional tables for prep and staging.
Davidson's structural heart team has been involved in transcatheter aortic valve replacements (TAVR) since the start of U.S. trials for these devices more than 15 years ago. The Northwestern program has now expanded to transcatheter repair and replacement of all four valves in the heart, as well as other types of structural heart interventions, and is seen as a leader in this space.
Northwestern Medicine also expanded access to TAVR and other interventions to its satellite suburban hospitals as the health system expanded over the past decade, purchasing several other hospitals in the Chicago region. These hospitals refer the more complex cases to the Bluhm Cardiovascular Institute in downtown Chicago.
TAVR now makes up more than 70% of aortic valve replacement procedures in the U.S. Despite this growth, Davidson and others at TVT said their surgical volumes have actually increased. This is attributed to more patients being referred than a decade ago, because many would not have qualified for surgery. More patients are also seeking help because they know there are minimally invasive options available. Some experts at TVT said the pervious notion about the size of the patient population for aortic disease that needed interventions as clearly not correct, as many more patients are presenting for case reviews than a decade ago, which has been a big surprise for cardiology.
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