Closing the gap between best evidence and common practice in surgical coronary revascularization: The rationale for superspecialization

In an effort to improve the outcomes for patients with valvular heart disease, there has been a concerted push over the past decade toward the creation of “Heart Valve Centers” or “Heart Valve Reference Centers.” In 2017 the European Society of Cardiology and European Association for Cardiothoracic Surgery even jointly published a document outlining the standards that would define such a center. The same year, six North American professional organizations preeminent in the fields of Cardiac Surgery, Interventional Cardiology, Anesthesiology, and Echocardiography published a Systems of Care Document entitled A Proposal to Optimize Care for Patients with Valvular Heart Disease. These same organizations recently published an update, stating that their document was necessary because “providing optimal care to patients with valvular heart disease (VHD) is an increasingly complex process, starting with early recognition and diagnosis.. MDT assessment, shared decision-making, and long-term follow-up.” They also note, “there are an increasing number of treatment options available to patients with VHD; yet not all patients are aware of or have access to the full spectrum of interventions.” The authors go on to propose an improved system of care for patients at VHD centers, whose primary goal is to optimize outcomes for all patients. They argue that the “case for centers with the ability to offer more comprehensive care is logical.” The authors state their intent is “to set performance and quality goals for a valve center to meet benchmarks to be considered either comprehensive or primary in a manner that would be more objective than simple self-designation.”.