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Getting the best from the Heart Team: Guidance for the structure and function of cardiac multidisciplinary meetings

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The Society for Cardiothoracic Surgery in Great Britain and Ireland are pleased to highlight The National Institute for Health and Care Excellence (NICE)  guidelines for the investigation and management of heart valve disease in adults.

The NICE guidelines are a timely document and is published at time that confidence in guidelines issued by The American College of Cardiology and European Society of Cardiology have become increasing strained.

NICE is recognized internationally and nationally, across the whole profession and importantly by patients as having the highest standards in producing guidelines and so this publication is timely and will restore confidence in professionals and patients.

SCTS welcomes the recognition by the committee that minimally invasive surgery will play an increasing role in surgery for valve disease. It has become increasingly apparent to SCTS that many patients prefer a minimally invasive approach over a sternotomy if they are suitable. Randomized controlled trials establishing the safety and efficacy of minimally invasive surgery for aortic valve surgery has been published in the UK and a large multicentre National Institute for Health care Research (HTA ) funded trial in mitral valve surgery has recently completed recruitment.

SCTS recognizes that the provision of minimally invasive valve surgery nationally is not uniform and supports the recommendation that patients are offered the opportunity to move to other surgeons and other units with the expertise to provide this service.

SCTS has taken a number of steps to improve the provision and assure the quality of MIS surgery nationally. This includes the establishment of an Innovations sub-committee within SCTS. This recommendation will allow SCTS to establish a formal process to define criteria for surgical and unit expertise to allow safe national dissemination and monitoring of outcomes through a national audit process.

SCTS also strongly supports the recognition of the clinical and cost effectiveness of surgery for the management of heart valve disease even in the elderly. It’s important that selection of patients for this technique is made in a multidisciplinary team and that surgeons get the opportunity to assess patients for suitability of surgery prior to transcatheter intervention. Our recent joint publication joint report with the Association for Cardiothoracic Anaesthesia and

Critical Care, the British Cardiovascular Intervention Society, the British Cardiovascular Society, and the British Heart Valve Society highlights that it’s important that selection of patients for intervention is made in a multidisciplinary team and that surgeons get the opportunity to assess patients for suitability of surgery prior to transcatheter intervention.

We support all the main recommendations of the draft document and it’s our opinion that overall, these recommendations will significantly improve access to care, timely diagnosis, appropriate intervention and outcomes both short and long term, for patients with heart valve disease.

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