Mitral repair best practice: proposed standards
- B Bridgewater1,
- T Hooper1,
- C Munsch2,
- S Hunter3,
- U von Oppell4,
- S Livesey5,
- B Keogh6,
- F Wells7,
- M Patrick1,
- J Kneeshaw7,
- J Chambers8,
- N Masani4,
- S Ray1
- 1South Manchester University Hospital, Manchester, UK
- 2Leeds General Infirmary, Leeds, UK
- 3James Cook University Hospital, Middlesbrough, UK
- 4University Hospital of Wales, Cardiff, UK
- 5Southampton General Hospital, Southampton, UK
- 6The Heart Hospital, University College Hospital, London, UK
- 7Papworth Hospital, Cambridge, UK
- 8Guy’s and St Thomas’ Hospital, London, UK
- Correspondence to:
South Manchester University Hospital, Southmoor Road, Manchester, UK;
- Accepted 17 October 2005
- Published Online First 26 October 2005
Objectives: To define best practice standards for mitral valve repair surgery.
Design: Development of standards for process and outcome by consensus.
Setting: Multidisciplinary panel of surgeons, anaesthetists, and cardiologists with interests and expertise in caring for patients with severe mitral regurgitation.
Main outcome measures: Standards for best practice were defined including the full spectrum of multidisciplinary aspects of care.
Results: 19 criteria for best practice were defined including recommendations on surgical training, intraoperative transoesophageal echocardiography, surgery for atrial fibrillation, audit, and cardiology and imaging issues.
Conclusions: Standards for best practice in mitral valve repair were defined by multidisciplinary consensus. This study gives centres undertaking mitral valve repair an opportunity to benchmark their care against agreed standards that are challenging but achievable. Working towards these standards should act as a stimulus towards improvements in care.
- ACC, American College of Cardiology
- ACTA, Association of Cardiothoracic Anaesthetists
- AF, atrial fibrillation
- AHA, American Heart Association
- BSE, British Society of Echocardiography
- EACTA, European Association of Cardiothoracic Anaesthesiologists
- EAE, European Association of Echocardiography
- TOE, transoesophageal echocardiography
Published Online First 26 October 2005
Competing interests: Appendix 1 give the various academic and political appointments held by the authors.
BB has attended various medical meetings sponsored by heart valve/repair ring manufacturers and has received occasional honoraria for lectures/teaching on mitral valve repair from Edwards Lifesciences and Medtronic
TLH has attended various medical meetings sponsored by heart valve/repair ring manufacturers and has conducted research into cardiomyoplasty and lung preservation sponsored by valve manufacturers.
CM has attended various meetings and symposia sponsored by heart valve manufacturers and has received occasional honoraria from St Jude Medical for organising and teaching on nurse study days.
SH has attended various medical meetings sponsored by heart valve/repair ring manufacturers
UvO has received occasional honoraria for lectures/teaching on mitral valve repair and surgery for atrial fibrillation from Edwards Lifesciences and Medtronic
SL has attended various medical meetings sponsored by heart valve/repair ring manufacturers and has received occasional honoraria for lectures/teaching on mitral valve repair from Edwards Lifesciences and Medtronic
JC has received open grants from various valve manufacturing companies for author-initiated research projects, and has had consultancy agreements with various valve manufacturers. He has delivered academic lectures about replacement heart valves at meetings organised by cardiologists or cardiac surgeons some of which are sponsored by valve manufacturing companies. He sits on the BSI and ISO committees on replacement heart valves and is on the editorial panel of the Journal of Heart Valve Disease, the International Journal of Clinical Practice, and the British Journal of Cardiology. He is involved in setting and maintaining standards in echocardiography for individuals and departments under the auspices of the British Society of Echocardiography, British Cardiac Society and Healthcare Commission.
NM runs an annual echo course, co-directed by Philips Medical Systems, for which he receives a Course Directors fee, has received honoraria from Philips and GE Medical for lectures/teaching in echocardiography, has received honoraria from various pharmaceutical companies for lectures to cardiologists/trainees and GPs and has conducted research supported by Medtronic and Edwards Inc
SR runs an annual echo course, co-directed by Philips Medical Systems, for which he receives a course director fee and has received honoraria from Philips for lectures/teaching