Boston-based Tufts Medicine is using a three-layer approach to meet rising demand for mitral valve care while keeping quality care.
Mitral valve disease rates rise steeply with age, and the number of Americans 65 and older is projected to grow by about one-third by 2036, according to the AAMC.
“Essentially, the patients are already here,” Panos Vardas, MD, chief of cardiac surgery at Tufts Medical Center and the surgical director for the structural heart program at Tufts Medical Center, said in an upcoming episode of Becker’s “Cardiology & Heart Surgery Podcast.” “We don’t expect the volume to just show up; we know it’s here. The focus is how to face this aging population, with more evidence and more prevalence of mitral valve disease.”
Here are the three layers of Tufts Medicine’s approach:
1. Identifying patients. Leaders use echo surveillance and outreach to referring cardiologists and primary care physicians to find patients and keep those already diagnosed with moderate mitral regurgitation from getting lost.
2. Triaging through a heart team. A multidisciplinary heart team evaluates each patient and directs them to the right treatment, whether surgical repair, valve replacement or a transcatheter option such as edge-to-edge repair or valve replacement.
“We have a single multidisciplinary mitral and structural heart team,” Dr. Vardas said. “We see patients together, and we have a weekly conference where we discuss them and everybody can share their opinion and assessment of the case. So there’s one entry point and one decision process for every patient. It doesn’t matter where the patient comes from, whether it’s our institution or an outside institution; there’s still one assessment and one best option for that specific patient.”
3. Expanding capacity. Adding operating room time alone isn’t enough, Dr. Vardas said.
“You have to be able to move patients through your center to the right treatment, and then look at capacity: OR and hybrid room time, imaging and imagers, ICU beds and the entire team,” Dr. Vardas said. “When you implement this model, you can absorb a higher volume of patients with mitral valve disease and, most importantly, give each patient the most appropriate treatment for them.”
For leaders who want to improve mitral valve disease outcomes in their market, Dr. Vardas recommends building or partnering with a “true mitral reference center.”
“That means a dedicated repair surgeon or two, expert imagers and echocardiographers, a heart team with expert structural cardiologists, and a referral system that brings patients there early,” he said. “That’s what drives the clearest volume-outcome relationship in valve surgery. In fact, the current American Heart Association and American College of Cardiology guidelines support repairing asymptomatic patients early, but only at centers where the likelihood of a durable repair is above 95% and expected mortality is under 1%.”
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