p.16 抽出テキスト

of guideline-directed medical therapy (GDMT), timely referral, and post-procedural follow-up.15,16 Broader aims include patient education, the training of physicians and nurse specialists, swift and efficient access to specialist care, and recruitment into clinical trials. Heart Valve Centres should ensure that their facilities match institutional and local statutory requirements (Table 5), report procedural volumes and outcomes, and monitor treatment quality. They hold responsibility for the training and education of surgeons, interventional and imaging cardiologists, dedicated nurses, and allied professionals.17,18 Expertise in the surgical management of coronary artery disease (CAD), vascular diseases, and complications must be available. New techniques should be taught by trained mentors using simulator models, when feasible, to minimize learning-curve effects. More broadly, Heart Valve Centres co-ordinate the management of patients with VHD across the entire Heart Valve Network, supporting services at community level, encouraging early referral, and promoting education and communication with other medical departments, referring cardiologists, primary care physicians, and rehabilitation clinics. 3.1.1 Composition of the Heart Team

The Heart Team is now an established feature of VHD programmes that has been formally endorsed by previous ESC/EACTS Guidelines19,20 and corresponding organizations worldwide.17 The value of the Heart Team approach has become increasingly apparent as options for the treatment of VHD have extended to include high-risk and inoperable patients (most of whom now undergo transcatheter interventions), and low-risk and asymptomatic patients (who derive prognostic benefit from increasingly safe procedures). Despite significant accumulation of data concerning the management of VHD over the last two decades, many patients in daily practice have clinical characteristics that do not match those of participants included in clinical trials. The Heart Team approach is therefore particularly helpful when there is uncertainty or a lack of strong evidence. The Heart Team meeting facilitates balanced presentation of all appropriate options for medical, interventional, and surgical treatment, using tools and techniques for shared decision-making.







  





	






    
 

 


 



 
 

 

 ­


  

	 



€

 

  

‚







Figure 1 The Heart Valve Network. HF, heart failure; VHD, valvular heart disease. Downloaded from academic.oup.com/eurheartj/article/46/44/4635/8234488 by guest on 07 October 2026