Who should be referred to a Heart Team?
Taking the path to treatment together
With transcatheter edge-to-edge repair (TEER), the mitral valve can be repaired. Yet it’s general cardiologists that make it happen.
By identifying the disease and referring your patients to a Heart Team, you can help them move toward the treatment decision that is right for them.
I breathed like an old man. I went to see a lung specialist, who examined me and then straight away sent me to see a cardiologist.
-Reinhold, MR patient
Mitral regurgitation (MR) can go undetected for years, with serious consequences1,2
If MR is suspected, echocardiography is the first choice of imaging technique to quantify MR severity, assess the status of the left ventricle and identify MR aetiology as degenerative (DMR) or functional (FMR).3,4
Transthoracic echocardiography is commonly used to assess MR, but evaluating its severity is complex. A comprehensive approach is advised, using a mix of quantitative measures and qualitative indicators.5
When you suspect MR in your patient, refer them to a Heart Team for evaluation.4
Use our patient screening tool to help you decide whether you should refer your patient with FMR to the Heart Team for further assessment.
Refer your MR patients to the Heart Team
A Heart Team’s multidisciplinary approach means that your patients will receive a thorough evaluation and a personalised treatment plan.6
DMR
The 2021 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS) recommendations on indications for intervention in severe, chronic DMR4
aLA dilatation: volume index ≥60 mL/m2 or diameter ≥55 mm at sinus rhythm.b Extended heart failure treatment includes the following: CRT, ventricular assist devices and heart transplantation.
AF: atrial fibrillation; CRT: cardiac resynchronisation therapy; CRT: cardiac resynchronisation therapy; HF: heart failure; LA: left atrium/left atrial; LVEF: left ventricular ejection fraction; LVESD: left ventricular end-systolic diameter; SPAP: systolic pulmonary arterial pressure.
FMR
The 2021 ESC/EACTS recommendations on indications for mitral valve intervention in chronic severe FMR4
aLVEF, predicted surgical risk, amount of myocardial viability, coronary anatomy/target vessels, type of concomitant procedure needed, TEER eligibility, likelihood of durable surgical repair, need of surgical mitral replacement, local expertise; b Particularly when concomitant tricuspid valve surgery is needed; c COAPT criteria (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation).
CAD: coronary artery disease; CABG: coronary artery bypass grafting; CRT: cardiac resynchronisation therapy; ESC: European Society of Cardiology; FMR: functional mitral regurgitation; GDMT: guideline-directed medical therapy; HF: heart failure; HTx: heart transplantation; LVAD: left ventricular assist device; LV: left ventricle/left ventricular; MV: mitral valve; PCI: percutaneous coronary intervention; RV: right ventricle/right ventricular; TAVI: transcatheter aortic valve implantation; TEER: transcatheter edge-to-edge repair;
More recently, the Heart Failure Association of the ESC (ESC HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA) and European Association of Percutaneous Cardiovascular Interventions (EAPCI) issued a joint position statement on the management of FMR in patients with HF.7
TEER could rewrite your patient’s story
I was operated on Thursday and was able to go back home the following Tuesday. I felt really good! I was allowed to start walking again a day later. The shortness of breath was, all of a sudden, gone. My quality of life has increased enormously.
-Reinhold, MR patient
“To hear that the patient is playing
golf again and going to the gym is
making the back of my neck tingle.
It’s really nice.*”
University Heart Centre Ulm, Ulm, Germany
* Expert opinions, advice and all other information expressed represent contributors' views and not necessarily those of Edwards Lifesciences.
References
- Chioncel O, Mebazaa A, Harjola VP, et al. Clinical phenotypes and outcome of patients hospitalized for acute heart failure: the ESC Heart Failure Long-Term Registry. Eur J Heart Fail. 2017;19(10):1242–1254. doi:10.1002/ejhf.890.
- Dziadzko V, Clavel MA, Dziadzko M, et al. Outcome and undertreatment of mitral regurgitation: a community cohort study. Lancet. 2018;391(10124):960–969. doi:10.1016/s0140-6736(18)30473–2.
- El Sabbagh A, Reddy YNV, Nishimura RA. Mitral valve regurgitation in the contemporary era: Insights into diagnosis, management, and future directions. JACC Cardiovasc Imaging. 2018;11(4):628–643. doi:10.1016/j.jcmg.2018.01.009.
- Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: Developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022;43(7):561–632. doi:10.1093/eurheartj/ehab395.
- Benjamin MM, Smith RL, Grayburn PA. Ischemic and functional mitral regurgitation in heart failure: natural history and treatment. Curr Cardiol Rep. 2014;16(8):517. doi:10.1007/s11886–014–0517–0.
- Batchelor WB, Anwaruddin S, Wang DD, et al. The multidisciplinary heart team in cardiovascular medicine: Current role and future challenges. JACC Adv. 2023;2(1):100160. doi:10.1016/j.jacadv.2022.100160.
- Coats AJS, Anker SD, Baumbach A, et al. The management of secondary mitral regurgitation in patients with heart failure: a joint position statement from the Heart Failure Association (HFA), European Association of Cardiovascular Imaging (EACVI), European Heart Rhythm Association (EHRA), and European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC. Eur Heart J. 2021;42(13):1254–1269. doi:10.1093/eurheartj/ehab086.
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