Surgical centres
Professional opinion papers increasingly recognise the need for specialist surgical centres particularly for mitral valve repair.35 The aim is a sufficiently high volume of cases performed by specialist surgeons to ensure repair rates appropriate to the aetiology of the disease. They must be supported in centres with the facilities (see table 2) necessary for good preoperative assessment and postoperative care. An integrated team approach involving cardiologists, surgeons, nurses, dieticians and other disciplines as relevant e.g. dentists, physiotherapists is expected to achieve maximum benefit. This is now widely used in cardiovascular disease as well as chronic pain, diabetes, depression. There is evidence that guidelines are better applied, risk factors modified better and that outcomes are improved.36
Conclusion
The key themes in these proposals to improve the care of patients with valve disease are:
- Team work
- Specialisation
- Links with other cardiac and extracardiac specialties
- Networks with protocols shared with the community and with referring hospitals
- Volume
- Data gathering and sharing.
close window and return to take test
References
1. Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M. Burden of valvular heart diseases: a population-based study. Lancet 2006;368:1005–11. http://dx.doi.org/10.1016/S0140-6736(06)69208-8
2. Anon 2001 Report of the National Confidential Enquiry into Perioperative Deaths. Pp 66-69. Department of Health.
3.Marijon E, Ou P, Celermajer S et al. Prevalence of rheumatic heart disease detected by echocardiographic screening. New Engl J Med 2007;357:470–6. http://dx.doi.org/10.1056/NEJMoa065085
4. Haskell WL, Alderman EL, Fair JM et al. Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford coronary risk intervention project (SCRIP). Circulation 1994;89:975–90. http://dx.doi.org/10.1161/01.CIR.89.3.975
5. Rosenhek R, Klaar U, Schemper M et al. Mild and moderate aortic stenosis. Natural history and risk stratification by echocardiography. Euro Heart J 2004;25:199–205. http://dx.doi.org/10.1016/j.ehj.2003.12.002
6. Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA et al. AHA/ACC Guideline for the management of patients with valvular heart disease. J Am Coll Cardiol 2014. http://dx.doi.org/10.1016/j.jacc.2014.02.536/
7. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J 2012;33:2451–96. http://dx.doi.org/10.1093/eurheartj/ehs109
8. Toledano K, Rudski LG, Huynh T et al. Mitral regurgitation: determinants of referral for cardiac surgery by Canadian cardiologists. Can J Cardiol 2007;23:209–14. http://dx.doi.org/10.1016/S0828-282X(07)70746-8
9. Iung B, Baron G, Butchart EG, et al. A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on valvular heart disease. Europ Heart J 2003;24:1231–43. http://dx.doi.org/10.1016/S0195-668X(03)00201-X
10. Taggu W, Topham A, Hart L, et al. A cardiac sonographer led follow up clinic for heart valve disease. Int J Cardiol 2009;132:240–3. http://dx.doi.org/10.1016/j.ijcard.2007.11.076
11. Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005;26:2714–20. http://dx.doi.org/10.1093/eurheartj/ehi471
12. Iung B. Management of the elderly patient with aortic stenosis. Heart 2008;94:519–24. http://dx.doi.org/10.1136/hrt.2007.122804
13. Grant SW, Devbhandari MP, Grayson AD et al. What is the impact of providing a transcatheter aortic valve implantation (TAVI) service on conventional aortic valve surgical activity, patient risk factors and outcomes in the first two years? Heart 2012;96:1633–7. http://dx.doi.org/10.1136/hrt.2010.203661
14. Chambers J, Lloyd G, Rimington HM, Parkin D, Hayes AM, Baldrock-Apps G, Topham A. The case for a specialist multidisciplinary valve clinic. JHVD 2012;21:1–4.
15. Lancellotti P, Rosenhek R, Pibarot P, et al. ESC Working Group on Valvular Heart Disease Position Paper–heart valve clinics: organization, structure, and experiences. Eur Heart J 2013. Published online ahead of print. http://dx.doi.org/10.1093/eurheartj/ehs443
16. Chambers J, Ray S, Prendergast B, et al. Specialist valve clinics: recommendations from the British Heart Valve Society working group on improving quality in the delivery of care for patients with heart valve disease. Heart 2013;99:1714–6. http://dx.doi.org/10.1136/heartjnl-2013-303754
17. Ling L, Enruiquez-Sarano M, Seward JB et al. Early surgery in patients with mitral regurgitation due to partial flail leaflet: a long-term outcome study. Circulation 1997;96:1819–25. http://dx.doi.org/10.1161/01.CIR.96.6.1819
18. Rosenhek R, Rader F, Klaar U et al. Outcome of watchful waiting in asymptomatic severe mitral regurgitation. Circulation 2006;113:2238–44. http://dx.doi.org/10.1161/CIRCULATIONAHA.105.599175
19. Takkenberg JJM, Rajamannan NM, Rosenhek R, Kumar AS, Carapetis JR, Yacoub MH. The need for a global perpsepctive on jheatt valve disease epidemiology. The SHVD working group on epidemiology of heart valve disease founding sytatement. JHBVD 2008;17:135–9.
20. Bocchi EA, Guimaraes G, Tarasoutshi F, Spina G, Mangini S, Bacal F. Cardiomyopathy, adult valve disease and heart failure in South America. Heart 2009;95:181–9. http://dx.doi.org/10.1136/hrt.2008.151225
21. Bridgewater B, Kinsman R, Walton P et al. Demonstrating quality: the sixth National Adult Cardiac Surgery database report. Henley on Thomas UK. Dendrite Clinical Systems Ltd, 2009.
22. Bolling SF, Li S, O’Brien SM, Brennan JM, Prager RL, Gammie JS. Predictors of mitral valve repair: clinical and surgeon factors, The Annals of Thoracic Surgery, 2012;90:1904–11. http://dx.doi.org/10.1016/j.athoracsur.2010.07.062
23. Gammie JS, O’Brien SM, Griffith BP, Ferguson TB, Peterson ED. Influence of hospital procedural volume on care process and mortality for patients undergoing elective surgery for mitral regurgitation, Circulation 2007;115:881–7. http://dx.doi.org/10.1161/CIRCULATIONAHA.106.634436
24. Chambers J, Ray S, Prendergast B, et al. Standards for heart valve surgery in a ‘Heart Valve Centre of Excellence’. Open Heart (in press)
25. Birkmeyer JD, Stukel TA, Siewers AE et al. Surgeon volume and operative mortality in the United States. New Engl J Med 2003;349:2117–27. http://dx.doi.org/10.1056/NEJMsa035205
26. Habib G, Hoen B, Tornon P et al. Guidelines on the prevention, diagnosis, ad treatment of infective endoacrditis. Euro Heart J 2009;30:2369–413.
27. Lalani T, Cabell CH, Banjamin DK et al. Analysis of the impact of early surgery on-in-hospital mortality of native valve endocarditis. Circulation 2012;121:1005–13. http://dx.doi.org/10.1161/CIRCULATIONAHA.109.864488
28. Delahaye F, Rial M-O, de Gevigney G, Echochard R, Delaye J. A critical appraisal of the quality of the management of infective endoacrditis. Jour Am Coll Cardiol 1999;33:788–93. http://dx.doi.org/10.1016/S0735-1097(98)00624-X
29. Botelho-Nevers E, Thuny F, Casalta JP, et al. Dramatic reduction in infective endocarditis-related mortality with a management-based approach. Arch Int Med 2009;169:1290–8. http://dx.doi.org/10.1001/archinternmed.2009.192
30. Chambers J, Sandoe J, Ray S, et al. The infective endocarditis team: recommendations from an international working group. Heart 2014;100:524-7. http://dx.doi.org/10.1136/heartjnl-2013-304354
31. Sandoe J, Barlow G, Chambers JB, et al. Guidelines for the diagnosis, prevention and management of Implantable Cardiac Electronic Device Infection.Report of a joint working party project on behalf of the British Society for Antimicrobial Chemotherapy (BSAC, host organisation), British Heart Rhythm Association (BHRA), British Cardiovascular Society (BCS), British Heart Valve Society (BHVS) and British Society for Echocardiography (BSE). Lancet (in press)
32. Kang D-H, Kim Y-J, Kim S-H et al. Early surgery versus conventional treatment for infective endocarditis. New Eng J Med 2012;366:2466–73. http://dx.doi.org/10.1056/NEJMoa1112843
33. Iung B, Rousseau-Paziaud J, Cormier B et al. Contemporary results of mitral valve repair for infective endocarditis. Jour Am Coll Cardiol 2004;43:386–92. http://dx.doi.org/10.1016/j.jacc.2003.09.034
34. DiMaio JM, Salerno TA, Bernstein R et al. Ethical obligation of surgeons to noncompliant patients: can a surgeon refuse to operate on an intravenous drug-abusing patient with recurrent aortic valve prosthesis infection? Ann Thorac Surg 2009;88:1–8. http://dx.doi.org/10.1016/j.athoracsur.2009.03.088
35. Bridgewater B, Hooper T, Munsch C, et al. Mitral repair best practice: proposed standards. Heart 2006;92:939–44. http://dx.doi.org/10.1136/hrt.2005.076109
36. Fletcher GF, Berra K, Fletcher BJ et al. The integrated team approach to the care of the patient with cardiovascular disease. Curr Probl Cardiol 2012;37:369–97. http://dx.doi.org/10.1016/j.cpcardiol.2012.04.001
close window and return to take test
All rights reserved. No part of this programme may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the publishers, Medinews (Cardiology) Limited.
It shall not, by way of trade or otherwise, be lent, re-sold, hired or otherwise circulated without the publisher’s prior consent.
Medical knowledge is constantly changing. As new information becomes available, changes in treatment, procedures, equipment and the use of drugs becomes necessary. The editors/authors/contributors and the publishers have taken care to ensure that the information given in this text is accurate and up to date. Readers are strongly advised to confirm that the information, especially with regard to drug usage, complies with the latest legislation and standards of practice.
Healthcare professionals should consult up-to-date Prescribing Information and the full Summary of Product Characteristics available from the manufacturers before prescribing any product. Medinews (Cardiology) Limited cannot accept responsibility for any errors in prescribing which may occur.
