Heart Valve Clinic: A Model for Treatment of Structural Heart Disease

Abstract

Background and Aim of the Study: Valvular heart disease (VHD) should be managed by a Heart Valve Team (HVT) for optimal treatment. Although the prevalence of VHD is increasing, an overall lack of universal implementation of the HVT continues to exist. Here we present our model of care within a Veteran’s Affairs Medical Center (VAMC). Materials and Methods: All patients referred to our VAMC with structural valvular disease have been managed within our multidisciplinary heart valve clinic since 2006. The heart valve clinic consists of a dedicated valve surgeon as well as both a dedicated noninvasive imaging cardiologist and cardiac MRI/CT cardiologist. Cases are reviewed on a weekly basis with multidisciplinary input to guide treatment strategy. Therapy includes medical management, facilitation of further diagnostic workup, and referral for operative intervention. Results: Between 2006 and 2015, 560 patients have been evaluated in HVC. Overall, new patient yearly volume has nearly tripled with now over 90 new consults seen yearly. Of the patients evaluated, 313 were referred for operative intervention with follow up post-operatively to affirm adequate post-procedural function. Following HVC referral trends, operative yearly volume has increased 33% over the last year years compared to the first three years of the program. The heart valve clinic has also matured to support a dedicated TAVR program. Conclusions: As the options for heart valve therapy and indications for surgery continue to evolve, a multidisciplinary team to guide decision making is imperative. We present the success and growth of our heart valve clinic within a VAMC as a structural model that can be translated into both the community and academic setting.