Structural Intervention Group

The BCIS Structural Working Group was formed in 2017 to meet the demands of the increasing practice of structural cardiac intervention, in particular the exponential growth of TAVI as an intervention for aortic stenosis, which is continuing to grow worldwide. In addition to TAVI, there is now a large number of other structural procedures and techniques (each with several CE marked devices) which need oversight from BCIS as the UK Professional Society.

The group includes representatives from the Heart Rhythm Society, the Society for Cardiac and Thoracic Surgeons, British Congenital Cardiac Association, NICE and NICOR, as well as individuals representing each of the mainstream structural procedures. The purpose of the group is to improve the quality and practice of structural intervention in the UK by developing position statements, guidelines and research/innovation. We aim to improve the quality of structural intervention in the UK and address inequity of provision across the country. To achieve this the group works with other BCIS working groups, Professional Societies, NHS commissioners and regulatory bodies to highlight any problems and provide expert consensus opinion on how to overcome these.

Fast-Track Pathway for treatment of Severe Aortic Stenosis

GIRFT has now published a Fast-track Pathway for Aortic Stenosis, in collaboration with BCIS, which should help improve access to aortic stenosis treatment. The document is available on the GIRFT website  or via the link below.

Importantly, the pathway identifies a “fast-track group”. The aim is for these patients to be seen in clinic within two weeks of referral, and treated within 8 weeks. The fast-track group consists of symptomatic patients with:

• Peak flow velocity >5m/s
• Peak flow velocity >4m/s with impaired LV function
• Bioprostheses with peak flow velocity >4m/s or severe AR

And without:
• Severe immobility
• Severe frailty
• Impaired cognition

This grouping is intentionally simplistic and therefore easy to remember and should help ensure that those with the most to gain are prioritised for early treatment. We recommend communicating this pathway to your senior hospital management, as well as to the cardiac network and integrated care board within which you work, seeking their support in its implementation. The precise pathway for delivering referral to treatment will undoubtedly vary in different networks, depending on local structures.

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