The Society for Cardiovascular Angiography and Interventions (SCAI) has published a consensus document and core curriculum that outline recommendations for the proper treatment of structural heart disease.
The recommendations stem from recent survey results that showed 62 percent of 107 respondents felt that structural heart disease training programs were lacking, particularly with the growing need for structural and valvular heart disease interventions.
SCAI wrote, “While training program content, standards, credentialing and board examinations for PCI have matured and become well developed, no such structure exists in the field of structural heart disease. Peripheral interventional therapies have lagged behind coronary interventions in this development, and structural heart disease is far behind.”
“The body of knowledge necessary for structural interventional programs remains to be clearly defined,” according to the document, which was published simultaneously in the Sept. 13 editions of Catheterization and Cardiovascular Interventions and the Journal of the American College of Cardiology: Cardiovascular Interventions.
Recommendations include that potential training centers perform more than one hundred procedures per year. However, the authors offered that “defining requirements for training and credentialing for established practitioners may be an even greater hurdle,” due to the fact that the number and types of procedures are always growing.
The society said a bigger focus must be place on tracking individual and facility-wide outcomes of surgical interventions in order to improve patient safety.
“In the absence of volume-based standards, what are the necessary elements for structural heart disease interventional training and certification?” SCAI asked. “The basic attributes necessary for both experience and training include knowledge of the field, necessary equipment, a training experience, including proctoring and/or the use of simulators, the development of independent experience, and ultimately some form of certification process and its maintenance that perhaps should be based on outcomes.”
The document recommended that a structural heart disease practitioner should have:
- Superlative basic catheterization skills with the ability to achieve unusual types of vascular access and manipulate various catheters, balloons and other devices;
- The ability to competently handle potential complications resulting from interventional treatment; and
- A knowledge base and interventional skills for a variety of complex structural heart diseases, including appropriate device selection, imaging needs, stenting techniques, managing complications and acute and long-term post-procedural care.
Training requirements should be aligned and categorized into “basic” and “advanced” levels and further categorized into either “acquired” or “congenital.”
Physician and other staff— adult and pediatric clinical cardiologists, cardiovascular surgeons, echocardiographers, radiologists, interventionalists, anesthesiologists, intensivists —should form a multidisciplinary approach to training for these interventional procedures, according to the recommendations.
Additionally, the society recommended that:
- The fellowship program develop formal didactic sessions that would include medical-surgical structural heart disease conferences, quality assurance, clinical follow-up, monthly reviews, consultation services and research resources; and
- The creation of a core lecture series in cardiovascular anatomy and physiology of structural and congenital heart disease physiology, pathophysiology, pharmacology, imaging technologies, radiation exposure and safety, clinical management and devices.
SCAI said that it will be “critical” for trainees to engage in a mentorship process to ensure proper care for patients with structural and congenital heart disease and to ensure that “future practice will incorporate a partnership in expertise with established centers of excellence in care of adults with congenital heart disease."
The curriculum was endorsed by the American College of Cardiology Foundation.