TCT: The must-haves when starting a TAVI program

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SAN FRANCISCO—Starting a transcatheter aortic valve implantation (TAVI) program at a hospital will require wisdom, education and a team-based approach, Augusto D. Pichard, MD, director of the Washington Hospital Center Cardiac Catheterization Laboratory, said during a twilight session Nov. 10 at the 23rd annual Transcatheter Cardiovascular Therapeutics (TCT) conference. Pichard informed the audience of what it takes to start and maintain a TAVI program, and said that above all, it will require team work.

“The first advice I would like to give you all is that you have to educate the general practitioner, the internist and the cardiologist,” Pichard said. “You have to remind them about exercise testing; now we know we always do exercise testing when symptoms are not clear.”

Additionally, he said that the members of the team must be educated on the value of valvuloplasty for diagnosis and as a bridge for palliation. They must also learn the interworkings of the TAVI procedure, and its results. Importantly, general practitioners must be educated on the TAVI procedure, as they are the ones administering patients’ diuretics, etc.

“The most fascinating part of this program is the ability to work with other specialties,” Pichard noted. “Learn from each other, grow beyond any difficulties and work together because no single physician can do it [TAVI]. As good as you might be, it is a multidisciplinary approach that will make the TAVI program successful.”

Pichard said that the surgical team must include staff with extensive valvular heart disease experience including interventional surgeons, electrophysiologists, nurses and ICU staff. “You need this type of team for your patients to do well,” he said.

In a big hospital, Pichard said that it will be ideal to choose two to three individuals to perform all of the valve procedures. “If you try to educate and initiate everyone in the cath lab at the same time to do valves, it will take a very long time to gets the program running.

“As successful as you may be, you cannot do this procedure without a special group of nurses, techs, fellows, nurse practitioners, etc.,” Pichard said.

Most importantly, Pichard noted that you must integrate a rehabilitation program. “These older patients have been so sick for so long that they have no muscle mass so once you give them normal cardiac output, they will need cardiac rehabilitation.”

The cardiac team must also possess the wisdom to select a good TAVI candidate.

“TAVI is a revolution in medicine and surgery. I welcome you all to it. Enjoy the excitement, work hard for its success and share it all with your team,” Pichard said. “Just remember, a patient’s well being is the ultimate objective.”