Expert Consensus Statement Addresses Transcatheter Pulmonic Valve Replacement

March 24, 2015—A new expert consensus statement was issued by the Society for Cardiovascular Angiography and Interventions (SCAI), American Association for Thoracic Surgery, American College of Cardiology, and the Society of Thoracic Surgeons that provides guidance on transcatheter pulmonic valve replacement (TPVR) for children and adults who were previously treated for congenital heart disease. 

The document, titled “Operator & Institutional Requirements for Transcatheter Valve Repair and Replacement, Part III–Pulmonic Valve,” will simultaneously be published online in Catheterization and Cardiovascular Interventions, the Journal of Thoracic and Cardiovascular Surgery, the Journal of the American College of Cardiology, and The Annals of Thoracic Surgery. 

Ziyad M. Hijazi, MD, serves as Chair of the writing committee. Dr. Hijazi is acting Chief Medical Officer and Chairman of the Department of Pediatrics at Sidra Medical and Research Center in Doha, Qatar.

As noted by the societies, the recommendations were developed by a committee of cardiac surgeons and interventional cardiologists to help physicians and hospitals offer consistent and appropriate care to TPVR patients. This is the third in a series of expert consensus statements for hospitals and physicians performing transcatheter valve procedures. The first two discussed aortic and mitral valve procedures.
 
According to SCAI, the consensus statement stresses that TPVR treatment recommendations should be made by a heart team consisting of interventional cardiologists, cardiac surgeons, noninvasive cardiologists, cardiac anesthesiologists, and radiologists.

The statement further recommends that institutions offering TPVR perform at least 150 congenital/structural catheterization procedures per year, including 100 that are interventional, as well as 100 open heart congenital surgical procedures. Institutions should have the heart-lung bypass support known as extracorporeal membrane oxygenation; echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging capabilities; a cardiovascular catheterization laboratory; and hemodynamic (blood pressure and electrocardiography) evaluation. Additionally, institutions should participate in a national registry. 

Because TPVR is a new treatment option, the committee stressed the importance of continuing to collect data on the procedure, including total numbers of TPVR in the United States and numbers of procedures performed by each operator and institution.
 
Additionally, the document advises that physicians should have experience with balloon valvuloplasty as well as stenting within pulmonary arteries and the right ventricular outflow tract. The statement also recommends that physicians attend peer-to-peer training and a simulated case if available. The first three procedures performed should be done so under the guidance of an experienced physician.
  
In the society’s press release, Dr. Hijazi commented, “Transcatheter valve treatments are allowing us to offer less invasive options to patients who were previously treatable only with open heart surgery or may not have been eligible for treatment at all. These procedures are complementing standard surgical approaches, allowing physicians to provide greater options for our patients.”

Dr. Hijazi added, “There is strong consensus that these new valve therapies should be performed under the guidance of a multidisciplinary heart team, involving both interventional cardiologists and surgeons. Increasing evidence shows a team-based approach provides the greatest quality care for patients with complex heart disease, including patients considering TPVR.”
 
“As physician experience with TPVR increases over time, complication rates are declining significantly, reflecting the importance of experience in improving patient outcomes,” concluded Dr. Hijazi in the SCAI press release.