Feature | Heart Valve Technology | July 26, 2018

TAVR Operator and Hospital Requirements Outlined in 2018 AATS/ACC/SCAI/STS Expert Consensus

A CoreValve TAVR valve seen in a CT scan looking down from the aortic arch into the left ventricle using reconstruction software from TeraRecon.

A CoreValve TAVR valve seen in a CT scan looking down from the aortic arch into the left ventricle using reconstruction software from TeraRecon.

July 26, 2018 — A new multi-societal expert consensus document has been released that summarizes the position of these partnering organizations on the availability, delivery, organization and quality of transcatheter aortic valve replacement (TAVR) cardiovascular care. The document was jointly released from the American Association for Thoracic Surgery (AATS), American College of Cardiology (ACC), Society for Cardiovascular Angiography and Interventions (SCAI), and the Society of Thoracic Surgeons (STS). 

The "2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement," was also publish online in the Journal of the American College of Cardiology (JACC)

With the rapid evolution and spread of TAVR technology, the documents states it is imperative that the cardiovascular community work together to identify the

criteria for performing these procedures safely and successfully. Such criteria serve to guide both practitioners and institutions in the development and maintenance of TAVR programs, in the spirit of optimizing quality outcomes. The unique qualifications to participate in this field comprise specific interventional skills, high-tech equipment, collaborative clinical management, evolving approaches for alternative access and multidisciplinary decision making, the authors wrote. 

The document includes the sections on the following areas:

• What Is New in the 2018 TAVR Operator and Institutional Requirements
• Structural Program Requirements 
• Procedural Volume 
• Multidisciplinary Team (MDT) 
• Knowledge Base and Skills 
• Proceduralist Formalized Training
• Facilities and Institutional Resources
• Process Program Requirements
• Patient Selection Requirements
• MDT Patient Case Conference Requirements
• Operational Details
• Patient Selection Considerations
• Frailty, Cognition, Quality of Life, Immobility and Disability
• Procedural Denial, Futility, QoL, Limited Life Expectancy
• Predictive Risk Models
• SDM Requirements
• Outcome Requirements
• Registry Requirements
• Criteria for Establishing a TAVR Program and Maintenance of Competence
• Requirements and Recommendations for New TAVR Programs 
• Requirements and Recommendations for Existing TAVR Programs
• Requirements for SAVR
• SAVR-only Programs
• Compliance with Document Recommendations

Read through a PDF version of the document.

 

 

Moving Toward National Coverage for TAVR

In addition to releasing the updated consensus document, the ACC—along with AATS, SCAI and STS, is submitting comments to Ceters for Medicare and Medicaid Services (CMS) in response to its request for public comments on a National Coverage Analysis (NCA) to reconsider the national coverage determination (NCD) for TAVR. The comments will use the document as a framework for supporting an updated NCD. CMS convened a panel July 25, of the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC) to discuss procedural volume requirements for hospitals and heart team members to begin and maintain TAVR programs. The ACC participated in the meeting. 

Lastly, based on the recommendations for external review and accreditation in the Expert Consensus document, as well as the CMS decision to reconsider its current TAVR NCD, the ACC is preparing to offer an external review and accreditation process that would assist hospitals in meeting standards such as multidisciplinary teams, formalized training, shared decision making and registry performance. 

For more more information: acc.org

 

Related TAVR Content:

Length of Stay Impacts TAVR Outcomes

VIDEO: Applications in Cardiology for 3-D Printing and Computer Aided Design — Dee Dee Wang, M.D.

Hospital Consolidation May Increase Access to TAVR, New Cardiac Technologies

VIDEO: Conscious Sedation for TAVR Procedures — Mario Goessl, M.D.

Recent Advances in Transcatheter Valve Technology

VIDEO: TAVR For Asymptomatic Severe Aortic Stenosis — Philippe Genereux, M.D.

How to Perform Transcaval TAVR Access — Adam Greenbaum, M.D.

VIDEO: Outcomes Following Urgent TAVR - Results from the TVT Registry — Sammy Elmariah, M.D.

TAVR Stands Equal to Surgical Valve Replacement

VIDEO: Clinical Outcomes With the Lotus TAVR Valve — Ted Feldman, M.D.

How to Build an Integrated Heart Team — Brijeshwar Maini, M.D., Brian Bethea, M.D.

VIDEO: TAVR for Degenerated Surgical Valves — Valve-in-Valve TAVR Procedures — Sammy Elmariah, M.D.

Advances in Heart Valve Technology in 2017
 

 

Reference: 

1. Joseph E. Bavaria, Carl L. Tommaso, Ralph G. Brindis, et al. 2018 AATS/ACC/SCAI/STS Expert Consensus Systems of Care Document: Operator and Institutional Recommendations and Requirements for Transcatheter Aortic Valve Replacement. Journal of the American College of Cardiology. July 2018. DOI: 10.1016/j.jacc.2018.07.002

Related Content

A patient who received HeartMate III LVAD system at ACC.18. The HeartMate 3 was the topic of of the the key late-breaking trials at #ACC18

A patient who received the HeartMate III LVAD system showing off his external battery pack. He served as a patient ambassador in the Abbott booth at ACC.18. The HeartMate III, with its magnetic levitated pump, showed a big reduction in clotting over previous LVADs in a key late-breaking trial at this year's conference.

Feature | ACC | March 27, 2018 | Dave Fornell
There were several notable presentations of new data on cardiovascular technologies at the recent 2018 American Colle
Drug Stops Dangerous Bleeding in Patients Taking Factor Xa Inhibitors

Connolly 

News | ACC | March 22, 2018
March 22, 2018 — The experimental drug...
Videos | ACC | March 21, 2018
DAIC Editor Dave Fornell takes a tour of some of the most interesting new technologies on the expo floor at
ACC 2018 Late-Breaking Trials Announced
News | ACC | March 21, 2018
Here is a list of the American College of Cardiology (ACC) 2018 annual meeting late-breaking clinical trials presente
Inhaled Therapy Ineffective in Difficult-to-Treat Heart Failure at ACC 2018.

Image from presentation, "Inorganic Nitrite Delivery to Improve Exercise Capacity in HFpEF: The INDIE-HFpEF Trial," Borlaug

News | ACC | March 20, 2018
March 20, 2018 — Four weeks of treatment with a novel inhaled medication failed to improve exercise capacity, daily a
More Deaths, Strokes Seen with Perioperative Beta Blocker One Year After Surgery

Image from presentation, "1-Year outcomes of perioperative beta-blockade in patients undergoing noncardiac surgery," Devereaux 

News | ACC | March 20, 2018
March 20, 2018 — During the 12 months after undergoing noncardiac surgery, patients with or at risk for heart disease
Trial for Gout Drug Meets Primary Endpoint, Raises Safety Concerns, image shows a CT scan showing gout in the knees.
News | ACC | March 20, 2018
March 20, 2018 — Febuxostat, a gout dr...
Canakinumab Doesn’t Prevent Prediabetes from Progressing to Diabetes according to a late-breaking study at ACC 2018.
News | ACC | March 20, 2018
March 20, 2018 — The anti-inflammatory...
Dabigatran Reduces Major Cardiovascular Complications in Patients With Myocardial Injury after Noncardiac Surgery
News | ACC | March 20, 2018
March 20, 2018 — Treatment with the blood-thinning drug dabigatran significantly reduced the risk of death, heart att
Statins May Bring Benefits at Time of Treatment for Heart Attack, Angina

Image from presentation, "Statins Evaluation in Coronary Procedures and Revascularization," Berwanger 

News | ACC | March 20, 2018
March 20, 2018 — Getting a large dose of a statin did not have an impact on major adverse cardiac events among a broa
Overlay Init