Welcome to Lesson 3 of ACC's Transcatheter Valve Certification Overview course. This learning activity was developed by myself. I am Liza St. Clair and I will also be narrating this presentation. The purpose of this lesson is to provide an understanding of the current treatments and therapies to treat patients diagnosed with valvular heart disease. Our objectives for this module is to provide an overview of heart valve disease and treatment options. We will specifically learn about the surgical versus transcatheter valve procedures. In addition, we will also review the current and prevalent challenges that the structural heart program and providers are struggling with to ensure the recommended treatment options are appropriate and meet the patient goals and expectations through a shared decision making process. To properly diagnose a patient with valvular heart disease, they must first undergo diagnostic testing. These tests require meticulous attention to detail as well as expertise in cardiac imaging and evaluation of hemodynamics. These tests will evaluate valve anatomy and etiology, concurrent valve disease, and associated abnormalities such as aortic dilation. It will evaluate left ventricular anatomy and calculate the ejection fraction. It will also determine the velocity, gradient, and valve area for stenotic lesions. It will calculate also the recurgent orifice area and volume. Tests will be compared to previous studies and results to compare and assess the progression of the disease. Because echocardiography remains the mainstay of the initial evaluation of all patients with valvular heart disease, it is recommended that the echo laboratory be an accredited program. Additional testing may be warranted and these latter tests mentioned on the slide will be part of the evaluation process if an intervention is warranted. Once valvular heart disease has been diagnosed, the patient should routinely be followed by their medical provider to assess any changes in their signs and symptoms, monitor the progression of the disease, and be encouraged to follow a heart-healthy lifestyle as this may alleviate some of the symptoms. With routine visits, the medical provider will also initiate guideline-directed medical therapy and medically manage their symptoms until stage D. In some cases, a valveoplasty might be conducted as a bridge until surgical or transcatheter intervention is needed. The traditional surgical valve intervention is an open-heart surgery, which in many cases involves a large sternotomy down the middle of the patient's chest. A transcatheter approach to aortic valve replacement or mitral valve repair most often takes place in either a cath lab or hybrid OR setting. Without having to perform a sternotomy, large catheters are used to navigate and implant the devices through a major blood vessel. However, there are many factors to consider when deciding which intervention will provide the best outcomes for the patient. The transcatheter valve heart team will need to consider the following. Is the patient eligible for a mechanical valve versus bioprosthetic? Long-term anticoagulation therapy is required for mechanical valves. Access site and navigation issues. If the patient can receive a transcatheter valve, are the patient's blood vessels tortuous and or is it not ideal to navigate a transcatheter device? Valve size available. What's the patient's valve size? Certain sizes may not be made available by the manufacturer. An anticipated re-intervention. This is especially for bioprosthetic valves. There is structural deterioration of bioprosthesis valves, usually within a 15-year period. And especially in younger patients, a re-intervention is probably anticipated. Also, we must take into account patient value and preferences. Also, we should look at the data and calculate the surgical risk score for mortality from the STS database and also consider the patient's frailty. Going forward with an intervention is a delicate balance. The balance between valve durability and the risk of bleeding and thrombolytic events favors the choice of a mechanical valve in patients less than 50 years of age, unless anticoagulation is not desired, cannot be monitored, or is contraindicated. Therefore, there really needs to be involvement of the whole heart team to ensure all factors are considered and to ensure the best patient outcomes and overall satisfaction with the course of treatment that is recommended. As a resource, additional information regarding shared decision-making can be found on ACC's CardioSmart website. This concludes Lesson 3 of 4. Thank you for your participation.

Transcatheter Valve Certification Overview

valvular heart disease

diagnostic testing

surgical interventions

transcatheter interventions