Advancing the Contemporary Multidisciplinary Heart Valve Team: Update on Priorities for Clinicians and Programs

Abstract

The multidisciplinary heart team (MDT) has been foundational to the rapid advancement of treatment options for valvular heart disease (VHD). Initially designed to guide treatment decisions for patients with aortic stenosis and procedural success of transcatheter aortic valve implantation, the MDT was intended to provide a responsive mechanism to meet the needs of patients and programs. Some of the unintended consequences of guideline endorsement and regulatory requirements have diminished the perceived value and threatened the engagement of team members. To maintain its impact, the VHD MDT must evolve to reflect contemporary priorities. For patients with aortic stenosis, the concept of the MDT must expand to address the significant barriers to timely detection, diagnosis, and referral and leverage its expertise to increase program capacity to accelerate access to care. The comprehensive mitral and tricuspid valve clinical pathway is in its infancy. For this patient group, the membership of the core MDT must be strengthened by the addition of expertise to support imaging diagnostics and procedural guidance, specialty team members who can guide the individualized clinical management of complex VHD, enhanced coordination of care and patient-centered processes, and consideration of unanswered clinical concerns. A recalibrated perspective on the key principles guiding the MDT for clinicians and programs offers opportunities to make the most of lessons learned by promoting quality of care and building a VHD collective and culture that can meet patients’ needs along their journey of care while prioritizing a nimble, tailored, efficient, and high-impact approach.