RESUMO
BACKGROUND: The US Food and Drug Administration recently approved a transcatheter aortic valve for patients for whom open heart surgery is prohibitively risky. METHODS: A multidisciplinary heart valve team partnered with administration to launch a transcatheter aortic valve replacement (TAVR) program. Clinical registries were used to show robust valve caseloads and outcomes at our Veterans Affairs (VA) facility and to project future volumes. A TAVR business plan was approved by the VA leadership as part of a multiphase project to upgrade and expand our surgical facilities. RESULTS: The heart valve team completed a training program that included simulations and visits to established TAVR centers. Patients were evaluated and screened through a streamlined process, and the program was initiated successfully. CONCLUSIONS: Establishing a TAVR program at a VA facility requires a multidisciplinary team with experience in heart valve and endovascular therapies and a supportive administration willing to invest in a sophisticated infrastructure.
Assuntos
Estenose da Valva Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Implante de Prótese de Valva Cardíaca/métodos , Hospitais de Veteranos , Equipe de Assistência ao Paciente/organização & administração , Desenvolvimento de Programas/métodos , Valva Aórtica , Estenose da Valva Aórtica/economia , Educação Médica Continuada , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/instrumentação , Próteses Valvulares Cardíacas , Implante de Prótese de Valva Cardíaca/economia , Implante de Prótese de Valva Cardíaca/instrumentação , Hospitais de Veteranos/economia , Hospitais de Veteranos/organização & administração , Humanos , Desenvolvimento de Programas/economia , Texas , Estados Unidos , United States Department of Veterans AffairsRESUMO
The diagnostic assessment of the severity of valvular heart disease in the older population is impacted by the anatomic and physiologic changes that accompany normal aging and by the interposition of diseases prevalent in the elderly. In this paper, the impact of those changes on the assessment of valvular heart disease will be reviewed. Special attention will be paid to the effects of age and disease on the measurement of the pressure drop and orifice area.