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.................................................................. 3 General comments This section defines and discusses concepts common to all the types of VHD including the Heart Team and Heart Valve Centres, the main evaluation steps of patients presenting with VHD, as well as the most commonly associated cardiac diseases. 3.1 Concepts of Heart Team and Heart Valve Centre The main purpose of Heart Valve Centres as centres of excellence in the treatment of VHD is to deliver optimal quality of care with a patient-centred approach. The main requirements of a Heart Valve Centre are presented in Table 4. This is achieved through high procedural volume in conjunction with specialized training, continuous education, and focused clinical interest. Heart Valve Centres should promote timely referral of patients with VHD for comprehensive evaluation before irreversible damage occurs. Decisions concerning treatment and intervention should be made by an active and collaborative Heart Team with expertise in VHD, comprising clinical and interventional cardiologists, cardiac surgeons, imaging specialists with expertise in interventional imaging,7,8 cardiovascular anaesthesiologists, and other specialists if necessary (e.g. heart failure specialists or electrophysiologists). Dedicated nursing personnel with expertise in the care of patients with VHD are also an important asset to the Heart Team. The Heart Team approach is particularly advisable for the management of high-risk and asymptomatic patients, as well as in case of uncertainty or lack of strong evidence. Heart Valve Clinics are an important component of the Heart Valve Centres, aiming to provide standardized organization of care based on guidelines. Access to Heart Valve Clinics improves outcomes.9 Physicians experienced in the management of VHD and dedicated nurses organize outpatient visits, and referral to the Heart Team, if needed. Earlier referral should be encouraged if patient’s symptoms develop or worsen before the next planned visit.10,11 Beside the whole spectrum of valvular interventions, expertise in interventional and surgical management of coronary artery disease (CAD), vascular diseases, and complications must be available. Techniques with a steep learning curve may be performed with better results at hospitals with high procedural volume and experience. The relationship between case volume and outcomes for surgery and transcatheter interventions is complex but should not be denied.1214 However, the precise numbers of procedures per individual operator or hospital required to provide high-quality care remain controversial as inequalities exist between high- and middleincome countries.15 High-volume TAVI programmes are associated with lower mortality at 30 days, particularly at hospitals with a high surgical aortic valve replacement (SAVR) volume.16,17 The data available on transcatheter mitral valve repair14,18 and, even more so, transcatheter tricuspid procedures are more limited. Since performance does not exclusively relate to intervention volume, internal quality assessment consisting of systematic recording of procedural data and patient outcomes at the level of a given Heart Valve Centre is essential, as well as participation in national or ESC/ EACTS registries. A Heart Valve Centre should have structured and possibly combined training programmes for interventionalists, cardiac surgeons, and imaging specialists13,19,20 (https://ebcts.org/syllabus/). New techniques should be taught by competent mentors to minimize the effects of the learning curve. Finally, Heart Valve Centres should contribute to optimizing the management of patients with VHD, provide corresponding services at the community level, and promote networks that include other medical departments, referring cardiologists and primary care physicians. 3.2 Patient evaluation The aims of the evaluation of patients with VHD are to diagnose, quantify, and assess the mechanism of VHD, as well as its consequences. Table 4 Requirements for a Heart Valve Centre Requirements Centre performing heart valve procedures with institutional cardiology and cardiac surgery departments with 24 h/7-day services. Heart Team: clinical cardiologist, interventional cardiologist, cardiac surgeon, imaging specialist with expertise in interventional imaging, cardiovascular anaesthesiologist. Additional specialists if required: heart failure specialist, electrophysiologist, geriatrician and other specialists (intensive care, vascular surgery, infectious disease, neurology). Dedicated nursing personnel is an important asset to the Heart Team. The Heart Team must meet on a frequent basis and work with standard operating procedures and clinical governance arrangements defined locally. A hybrid catheterization laboratory is desirable. The entire spectrum of surgical and transcatheter valve procedures should be available. High volume for hospital and individual operators. Multimodality imaging including echocardiography, CCT, CMR, and nuclear medicine, as well as expertise on guidance of surgical and interventional procedures. Heart Valve Clinic for outpatient and follow-up management. Data review: continuous evaluation of outcomes with quality review and/or local/external audit. Education programmes targeting patient primary care, operator, diagnostic and interventional imager training and referring cardiologist. CCT = cardiac computed tomography; CMR = cardiac magnetic resonance. ESC/EACTS 2021 .................................................................................................................................................................. Downloaded from academic.oup.com/eurheartj/article/43/7/561/6358470 by guest on 07 October 2026