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Developing a Heart Team approach to Transcatheter valve therapy
What is India Valves Heart Team?
Transcatheter Valve therapy is growing exponentially and world-wide evidence has shown that outcomes are directly related to heart team experience in patient selection, planning and performing such procedures. Such therapies are still at its early stages of adoption in India with limited experienced teams. India Valves Heart Team allows a highly specialised team to be contracted by any centre to deliver such therapies. This is envisaged to deliver consistent positive/superior outcomes regardless of the experience of the centre at the same time training the specialists at that centre simultaneously. The net result will be consistent good outcomes for patients at the same time allowing structured training for specialists intending to adopt such therapies at their centre.

Who are the specialists in India Valves Heart Team?
There are a number of carefully vetted specialists within India Valves Heart Team that includes experienced TAVR operators, Cardiac Structural Interventionists, Cardiac Surgeons, Cardiac Anaesthesiologists, Endovascular Interventionists, Intensivists and a whole range of paramedical crew including perfusionists, anaesthesia assistants, cath lab technicians and clinical specialists. To become a part of India Valves Heart Team, there is a strict set of criteria to substantiate one’s experience and heart team commitment. This large team are capable of dealing with any transcatheter valve therapy requirement in the country and also to manage any peri-procedural complications. The team required for each case will be selected based on patient profile, centre experience and need.

What is the expertise of India Valves Heart Team?
The specialists within India Valves Heart Team are highly experienced operators who are proctors for various therapies and who have experience with a wide variety of transcatheter valve technologies. The operators have published widely and have the experience of selecting the right patients and using the right valve technology and additionally they have the experience of performing a cost-effective procedure conducive to Indian healthcare model. The entire team are based in India. The team have access to a wide range of transcatheter valve technologies in the world and all technologies currently available in India allowing the team to treat a wide range of patients requiring transcatheter valve therapies.

How does India Valves Heart Team work?
Once contacted by phone or email, a dedicated coordinator will collect the details of the patient, details of the available expertise at the referral centre and the facilities available within that centre. The coordinator will also connect the caller (doctor from the centre) to a TAVR specialist to get more information. If the patient is lacking some essential tests, then those would be advised by the TAVR specialist. Once all the test results are available (Usually an echocardiogram and a gated cardiac CT), the information will then be used to conduct a Heart Team Discussion amongst India Valves Heart Team members. A decision will be made as to what treatment will be suitable for the patient and what device is best for the patient. The outcome will be sent formally through a letter to the centre’s referring doctor along with a telephone discussion to clarify any concerns. The centre will also at that time be notified of the total cost of the procedure. Once agreed, then a date will be finalised by the centre’s doctor. The pre-chosen heart team will travel to that centre on the day before the procedure or several hours before the procedure to check that patient’s data is as expected and all pre-procedural precautions are taken. A quick survey of the facilities will also be assessed by the heart team. The procedure will be performed and the heart team, based on centre’s experience will stay the following day if needed and then leave after declaring patient’s safety.

What are the potential procedures covered by India Valves Heart Team?
India Valves Heart Team delivers the following transcatheter valve therapy procedures: 1. Transcatheter Aortic Valve Replacement (TAVR) (Transfemoral, Transaortic, Transapical, Transsubclavian, Transvenous) 2. Aortic Valve-in-valve implantation 3. Mitral Valve-in-valve implantation 4. Tricuspid Valve-in-valve implantation 5. Percutaneous Pulmonary Valve Implantations (PPVI) 6. Pulmonary Valve-in-valve implantation India Valves Heart Team also delivers the following Aortic Solutions: 1. EVAR 2. TEVAR 3. Fenestrated Thoracoabdominal Aortic Reconstructions 4. Acute Aortic Dissection Therapy (Surgical, Endovascular and Hybrid) 5. Chronic Aortic Dissection Therapy (Surgical, Endovascular and Hybrid) 6. Aortic Arch Interventions (Surgical, Endovascular and Hybrid)

What are the various devices available for use by India Valves Heart Team and how much do they cost?
The various transcathter valve devices available for commercial use by India Valves Heart Team include: 1. Medtronic Corevalve and Evolut R 2. Abbott (St Jude) Portico 3. Braile Inovare 4. Venus Medtech 5. Edwards Sapien XT and S3 The cost of the procedure largely depends on the device chosen and the patient portfolio which dictates the procedural complexity and need for bail-out procedures. The prices quoted however would be the cheapest in India as the idea of India Valves Heart Team is to spread cost effective and safe therapy across India. The cost covers the device and all specific accessories for the transcatheter valve procedure, professional fee for heart team and logistics. The cost for aortic procedures (surgical, endovascular or hybrid) can only be estimated after analysing the patient demographics. Once the patient details have been analysed, the referring doctor or the referring centre will get to know the total cost for them to make the decision

What is the advantage for a hospital in contracting India Valves Heart Team and its services?
Transcathter Valve Therapies requires highly specialised teams and the volume of such therapies are not high. Hiring such teams permanently on a full-time basis within a hospital/Center may not be cost effective. Availing India Valves Heart Team’s services on a case-by-case basis allows cost effective, consistent and safe delivery of treatment in the same hospital so long as minimal facility requirement by India Valves Heart Team is satisfied. As a result, patients visiting the hospital need not be referred to another centre and can get their treatments within their usual centre under their usual clinician looking after them.

What is the advantage for a physician/surgeon in contracting India Valves Heart Team’s services?
Physicians/Surgeons can get one to one help from an accredited and highly experienced TAVR specialist. In the process of using India Valves Heart Team’s services, they can opt to be trained towards becoming an independent TAVR operator. Once they opt, the physician/surgeon will undergo staged training and proctoring towards being signed off as a TAVR operator and will get regular updates on any new technology taken up by India Valves Heart Team. Physician/Surgeon will also get complimentary registrations to HVFI programmes.

What are the details required by India Valves Heart Team to give an opinion?
A list of patient demographics including some blood test results will be collected. The entire echocardiogram video of the patient on a CD or uploaded onto the website as video files are required. For a TAVR, a gated cardiac CT scan and a CT aortogram is required. The Gated Cardiac CT scan should be from a CT scanner no less than a 64 slice CT scanner with data acquisition of 0.5mm slice thickness. The aortogram should cover cranially from the carotids and caudally to the common femoral bifurcation. The entire CT data (Gated Cardiac CT scan and CT Aortogram) should be sent as a DVD or uploaded onto the website for analysis. The best format to upload all image data including echocardiogram and CT scan would be in Dicom format. The best way to send all this information is online through www.indiavalves.in which has an easy online uploading system which is quick and cost effective.

How does one contact India Valves Heart Team?
You could contact by phone or email or through the website. The website www.indiavalves.in allows anyone to contact the India Valves Heart Team. They can also upload patient’s CT scan and other patient data and they can get an opinion. The phone number and email address are also on the website