Multidisciplinary decision-making in mitral valve disease:the mitral valve heart team

BackgroundAlthough decision-making using the heart-team approach is apparently intuitive and has aclassI recommendation in most recent guidelines, supportive data is still lacking. The current study aims to demonstrate the individualised clinical pathway for mitral valve disease patients and to evaluate the outcome of all patients referred to the dedicated mitral valve heart team.MethodsAll patients who were evaluated for mitral valve pathology with or without concomitant cardiac disease between 1January 2016 and 31December 2016 were prospectively followed and included. Patients were evaluated, and atreatment strategy was determined by the dedicated mitral valve heart team.ResultsOne hundred and fifty-eight patients were included; 67patients were treated surgically (isolated and concomitant surgery), 20 by transcatheter interventions and 71conservatively. Surgically treated patients had ahigher 30-day mortality rate (4.4%), which decreased when specified to adedicated surgeon (1.7%) and in primary, elective cases (0%). This was also observed for major adverse events within 30days. Residual mitral regurgitation >grade2 was more frequent in the catheter-based intervention group (23.5%) compared to the surgical group (4.8%).ConclusionIn conclusion, the implementation of amultidisciplinary heart team for mitral valve disease is avaluable approach for the selection of patients for different treatment modalities. Our research group will focus on afuture comparative study using historical cohorts to prove the potential superiority of the dedicated multidisciplinary heart-team approach