Centres of excellence in heart valve surgery: are there standards for best practice?

The growing prevalence of valvular heart disease represents a major challenge in terms of short-term and long-term management and surveillance.1 ,2 Despite well-defined guidelines, appropriate detection and follow-up strategies are still poorly applied in valvular heart disease.3 ,4 In many countries, valvular heart diseases are managed by non-experts in the field, which may result in misdiagnosis and lead to inappropriate delays in decisions about valve interventions, and compromise patient outcome. The establishment of multidisciplinary services delivered by experts in valvular heart disease in a well-structured environment in order to provide specialised and centralised evaluation, care and education to patients with valvular heart disease has become the basis of implementation of ‘Heart Valve Centre of Excellence’ across Europe and outside Europe.5 Centres with a dedicated ‘Heart Valve Clinic’ have a designed pathway to diagnose and monitor patients with valvular heart disease. They regroup a multidisciplinary team of cardiologists, nurses, radiologists, anaesthesiologists, and surgeons proficient in diagnosing and treating all cardiac valve syndromes and disorders. This involves sophisticated cardiac valve symptoms recognition, diagnostic techniques such as three-dimensional echocardiography, cardiac magnetic resonance, cardiac CT and cardiac catheterisation.6 The ‘Heart Valve Clinic’ also provides help in optimising and monitoring medical treatment, assisting the general cardiologists for clinical decision-making, determining the correct timing and type of intervention, referring the patient to the most suitable surgeon, assessing results after intervention, and informing patients to motivate them to follow their prescribed medications and …