TAVR is Performed by a Multidisciplinary Team Co-Directed by Interventional Cardiologists and Cardiac Surgeons
TAVR must be performed by a multidisciplinary team (MDT) that is co-directed by both an interventional cardiologist and a cardiac surgeon, with both specialties sharing responsibility for the procedure and patient outcomes 1.
Core Procedural Team Structure
The defining principle is an institutionally-based joint cardiology and cardiac surgery effort 1. TAVR programs should only be established if this multidisciplinary partnership exists 1.
Primary Operators (TAVR Proceduralists)
The term "TAVR proceduralist" refers to either interventional cardiologists or cardiac surgeons who perform the actual procedure 1. Both specialties can serve as the primary operator, provided they possess:
- Extensive knowledge of valvular heart disease
- Expertise in both TAVR and surgical aortic valve replacement (SAVR) outcomes
- Technical skills in catheter-based interventions
- Mastery of intraprocedural imaging interpretation
- Understanding of radiation safety and fluoroscopy 1
Required MDT Members
Beyond the co-directors, the comprehensive team must include 1:
- Echocardiographic and radiographic imaging specialists (for CT interpretation and intraoperative TEE)
- Cardiovascular anesthesiologist (though not always present with conscious sedation for transfemoral cases)
- Nurse practitioner/physician assistant for pre- and periprocedure care
- TAVR administrative coordinator/program navigator
- Data manager for registry reporting
Essential Consultative Resources (24/7 availability) 1:
- Electrophysiology for permanent pacemaker implantation
- Neurology with stroke team
- Vascular surgery support
- Renal medicine with dialysis capabilities
Patient Evaluation Requirements
One cardiac surgeon and one cardiologist with TAVR knowledge must both evaluate every patient being considered for the procedure 1, 2. This represents an evolution from the initial 2013 requirement of two cardiac surgeons 1.
The evaluation should optimally occur jointly in a multidisciplinary valve clinic using a shared decision-making process 1, 2. Documentation from both specialties must be available to the MDT, including rationale for treatment recommendations 1.
Critical Distinction from Traditional Cardiac Surgery
Unlike traditional cardiac surgery where cardiac surgeons operate independently, TAVR fundamentally requires partnership between interventional cardiology and cardiac surgery 1. The underlying principle is that no single specialty possesses all necessary skills for optimal patient outcomes 1.
This collaborative model has been the cornerstone of transcatheter valve program success since inception 1.