South Tees Hospitals NHS Foundation Trust



Aortic Valve MDTAll patients being referred for aortic valve intervention to be discussed. Patients will be triaged by the MDT co-ordinator, Specialist Nurse and MDT chair into 3 groups prior to the MDT:Group 1:Patients aged 80 years or olderGroup 2:Patients aged 75-79Group 3:Patients aged <75Patients in group 1 will, in general, be directed towards TAVI as the preferred treatment option. MDT recommendation by protocol.Patients in group 3 will, in general, be directed towards sAVR as the preferred treatment option. MDT recommendation by protocol.Patients in group 2 will require full MDT discussion to determine the preferred strategy. Where both options are felt to be reasonable, patients will be reviewed in OP by both cardiac surgeon and TAVI cardiologist to discuss the merits of each approach. Many patients will have medical or technical complexities which will require full MDT discussion rather than recommendation by protocol. Potential examples are included below, but are not intended to be exhaustive:Group 1: Uncertain severity of aortic valve disease / indication for interventionUnsuitable for TF accessBicuspid valvesSevere, complex coronary artery diseaseSevere mitral valve diseaseAscending aorta >50mm CT features conferring high risk for complications with TAVIWhere comorbidities raise doubt as to whether intervention might not be beneficialGroup 3: Uncertain severity of aortic valve disease / indication for interventionPrevious cardiac surgeryEuroscore 2 > 4%Significant ascending aortic calcificationAny patient who the referrer or surgeon feels is not low risk for surgical intervention, eg substantial co-morbidities; restricted mobility/conditions that may affect rehabilitation after the procedure.Minimum dataset for MDT discussionAll patients: Current symptoms & trajectoryMedical history / comorbiditiesUp to date echo - images and reportUp to date angiogram - images and reportUp to date blood results (FBC, U&E)ECGLung function tests +/- ABGs if history of lung diseaseInformation on prognosis for other potentially life limiting conditionsMOCA or other assessment of cognitive function if history of dementiaComment on frailty if appropriateOpinion from referrer / patient as to preferred treatment where applicablePatients aged 75 and above (groups 1 &2)As above plus:CT TAVI (gated cardiac study, non gated contrast aortogram from lung apices to femora arteries) - images and report.Significant incidental findings to be assessed and investigated by referring team.Referrals without the above minimum requirements will be rejected. Standard letter to be sent / emailed by MDT co-ordinator to referrer indicating missing information; copy to patient.Referrals and full dataset must be available by 0930 on the day prior to the MDT. Referrals received after this time or with incomplete information will be held over until the next week’s meeting.Urgent IP referrals. Full assessments, as above. Once complete, MDT discussion between referrer, TAVI cardiologist, Cardiac surgeon on call and imaging / general cardiologist (may be electronic). Decision to be recorded in case record.MDT meeting and outputMeeting to be held weekly. Scheduled for 90 minutes.Chaired by imaging cardiologist or named deputy. Referrals to be triaged by MDT coordinator, supported by TAVI SpN / MDT chair for clinical input. TAVI SpN will attend MDT.Quorate – minimum of one TAVI cardiologist, one cardiac surgeon, one imaging / general cardiologist. Local MDTs without the above are not quorate.Anaesthetic / Elderly care / Vascular MDT advice to be sought for individual cases where appropriate.Open to all cardiologists, cardiac surgeons, anaesthetists, trainees and SpNs.MDT discussion / recommendation to be recorded at weekly meeting. Recommendation letter to be sent to referring clinician, GP, patient and other relevant HCPs.Intention to work towards electronic communication of recommendation to referring clinician and secretary on same day as MDT.MDT recommendations as follows:List for sAVR. Appointment to be made in surgical clinicList for TAVI / PCI / BAV. Appointment to be made in TAVI interventional clinicEither option appropriate. Appointments to be made in surgical and TAVI interventional clinicUnsuitable for intervention – reasons to be providedFurther investigation required. MDT to provide detail and whose responsibility to organise ................
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