Interventional Valve Surgery: Building a Team and Working Together

Transcatheter aortic valve implantation (TAVI) is a new modality that may change the therapeutic landscape in the management of aortic valve stenosis. Despite the excellent results of surgical aortic valve replacement, TAVI has the potential to revolutionize the treatment of elderly and high-risk patients with aortic stenosis. It therefore constitutes a new reality that cardiac surgeons have to acknowledge. As TAVI indications and techniques become better defined, the importance of a team approach to the implementation and performance of TAVI is becoming increasingly evident. The surgeon has a crucial role to play in the introduction, development, and sustainability of TAVI at any institution. In this article, we discuss the procedural technique involved in TAVI, as well as the cardiologist and heart surgeon individualities and team dynamics. We make a case for judicious team-based adoption of TAVI technologies, considering that evidence-based and health economics data are not yet available. We also illustrate how a team approach may lead to improved outcomes, better patient and institutional acceptance, and a better definition of the therapeutic niche of TAVI modalities, amid the excellent results of conventional aortic valve replacement surgery.