Building Your Care Team and Preparing for the First Visit

Because aortic stenosis (AS) is a complex, mechanical condition that may involve surgery or advanced catheter-based procedures, your care should not be managed by a single doctor. Modern medical guidelines strongly recommend that patients with severe AS be evaluated by a multidisciplinary Heart Team ^[1][2].

This team approach ensures that your treatment is not just based on one specialist’s preference, but on a collective review of your anatomy, your overall health, and your personal life goals ^[3][4].

Your Specialist Lineup: The Heart Team

A high-quality heart program coordinates several different types of specialists to create a single, unified plan for you ^[1].

• General Cardiologist: Often your primary point of contact, they monitor your symptoms and coordinate your long-term heart health.
• Interventional Cardiologist: A specialist in minimally invasive, catheter-based procedures like TAVR ^[1].
• Cardiothoracic Surgeon: A specialist in heart surgery, including traditional and minimally invasive SAVR ^[1].
• Cardiac Imaging Specialists: Doctors who use advanced technology (like 3D echos and CT scans) to map the exact size and shape of your heart and valve ^[1][5].
• Anesthesiologists and Geriatricians: Specialists who evaluate your physical “frailty,” cognitive health, and ability to recover safely from a procedure ^[1][6].

Preparing Your “Records Kit”

When you visit a specialized valve clinic for the first time, the doctors need to see more than just the summary reports from your previous tests. They need the raw data to perform their own measurements ^[5][7]. Do not assume your records have been sent electronically. To avoid delays, you should physically bring the following, or ensure they have been securely transferred in advance:

The Imaging Essentials

• Echocardiogram (Echo) on a CD/USB or Secure Transfer: You need the actual “moving pictures” of your heart, not just the two-page paper report. This allows the team to verify the severity of your narrowing ^[5].
• Cardiac CT Scan or CTA: These high-resolution images are essential for planning a TAVR, as they show the exact size of your aorta and the location of your coronary arteries, though not all surgical patients need one ^[7][8].
• Coronary Angiogram: If you have had a “heart cath” recently, those results help the team decide if they need to fix blocked arteries at the same time they replace your valve. (A stress test may also have been done, but evaluates physiologic response differently) ^[9].

Your Clinical History

• A Symptom Timeline: Write down exactly when you first noticed changes. For example: “Six months ago, I could walk the dog for 20 minutes; now I have to stop after 5 minutes because of chest pressure” ^[10].
• Complete Medication and Allergy List: Include dosages and why you take each one, especially blood thinners or blood pressure medications.
• Prior Operative Reports: If you have had any previous chest or heart surgeries, those records are critical for the surgeon’s planning.
• Support & Logistics: Bring a support person and a list of your accessibility or recovery needs.

How to Assess Your Heart Team

Not all heart programs have the same level of experience. When choosing where to have your procedure, you have the right to ask about the team’s track record and quality metrics ^[11].

1. Ask About Procedure Experience

Research shows that hospitals and doctors who perform more procedures generally have better outcomes ^[11].

• TAVR Experience: In an early national study, hospital mortality for TAVR dropped significantly as the team gained experience—from roughly 3.5% at their first case down to 2.1% by their 400th case ^[11].
• Benchmarks: Historically, some organizations suggested benchmarks like performing at least 50 TAVR and 70 SAVR procedures annually to maintain expertise, but risk-adjusted outcomes matter more than volume alone ^[12].

2. Check Registry Participation

Top-tier programs participate in national quality registries, such as the STS National Database (for surgery) or the STS/ACC TVT Registry (for TAVR) ^[13][14]. These registries track “risk-adjusted” outcomes, meaning the team is measured on how well their patients do compared to other hospitals treating patients with similar health risks ^[14].

3. Observe the “Shared Decision-Making” Process

A good Heart Team does not just “tell” you which procedure to have. They should engage in shared decision-making—a process where they explain the medical evidence (the risks and benefits) and then ask about your values ^[3][15].

• Values Matter: Are you more concerned about a fast recovery (favoring TAVR) or a valve that has a long track record (favoring SAVR)? ^[16][17]
• Decision Aids: Many centers now provide written pamphlets or digital “decision aids” to help you compare your options side-by-side ^[16][18].

Setting Realistic Expectations

During your first visit, the team will likely perform a “frailty assessment.” This might include a simple test of your walking speed or your grip strength ^[6]. This isn’t just about your age; it’s about understanding how your body will handle the stress of a procedure and what kind of support you will need during recovery ^[6][19].

Treat this first consultation as the start of a “lifetime plan” for your heart. Even after your valve is replaced, you will need a team that offers structured follow-up to ensure your new valve continues to function well for years to come ^[20][21].