Heart Valve Centre
Definition
A Heart Valve Centre is a specialised cardiovascular unit that meets defined structural, procedural volume, and outcome standards for the comprehensive management of valvular heart disease (VHD). Heart Valve Centres operate within a regional Heart Valve Network that connects referring hospitals and specialists to the centre for complex case evaluation and management.
Key Concepts
Heart Valve Network Model
- All VHD patients should be managed within a regional Heart Valve Network integrating community cardiologists, general hospitals, and specialised Heart Valve Centres
- Less complex VHD: managed locally with remote Heart Team input
- Complex VHD or procedures: concentrated at Heart Valve Centres where expertise and volume are sufficient
- The Heart Valve Network facilitates triage, shared decision-making, and follow-up coordination sources/vhd-esc-2025
very high
Heart Team Composition
- Minimum: cardiac surgeon, interventional cardiologist, and imaging cardiologist (echocardiographer)
- Extended team for complex cases: electrophysiologist, HF specialist, anaesthesiologist, geriatrician, clinical nurse specialist, and patient representative
- The Heart Team recommendation must be discussed with and communicated to the informed patient — shared decision-making is a Class I mandate sources/vhd-esc-2025
very high
Requirements for a Heart Valve Centre
- Minimum procedural volumes for: TAVI, SAVR, MV repair (open and transcatheter), TV surgery, and complex interventions
- On-site cardiac surgery and imaging expertise (echo, CCT, CMR)
- Multidisciplinary Heart Team meetings with documented decision-making
- Participation in national/international registries for outcome tracking
- Provision of 24/7 coverage for acute VHD emergencies sources/vhd-esc-2025
very high
Complex Procedures at High-Volume Centres
Procedures ideally concentrated at the most experienced Heart Valve Centres:
- Minimally invasive MV repair
- VSARR (valve-sparing aortic root replacement) and AV repair
- Transcatheter MV and TV interventions (TEER, TMVI, transcatheter TV replacement)
- Combined multi-valve procedures
- Redo cardiac surgery for prosthetic valve complications
- TAVI in high anatomical risk (BAV, narrow aortic root, low coronary ostia) sources/vhd-esc-2025
very high
Volume-Outcome Evidence
- Higher procedural volumes at experienced centres are associated with better outcomes in MV repair, TAVI, and complex combined procedures
- Low annual volume of PMC in high-income countries mandates restriction to specialist operators to maintain safety
- Repair rates for MV prolapse vary dramatically between centres — referral to high-volume repair centres is recommended sources/vhd-esc-2025
very high
Contradictions / Open Questions
- Minimum volume thresholds for Heart Valve Centre designation vary between countries and guideline documents — no universally agreed threshold exists
- Centralisation of complex VHD care may limit access for patients in remote geographic areas; telemedicine and network models are proposed but incompletely validated
- The impact of Heart Team decision-making on clinical outcomes vs individual operator decision-making has not been studied in RCTs
Connections
- Related to concepts/Valvular-Heart-Disease
- Related to concepts/TAVI
- Related to concepts/Primary-Mitral-Regurgitation
- Related to concepts/Tricuspid-Regurgitation