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20th June 2023

The British Cardiovascular Intervention Society welcomes the involvement of allied health professionals with advanced skills in structural heart disease programs and recognises the autonomy of sites to direct their own programs, within an adequate governance structure. TAVI programs in the UK are dependent on dedicated specialist nurses who administer those programs, run the MDT, often load the valves, and sometimes assist in procedures as a second operator.

As medicine has changed so there has increasingly been a role for allied health practitioners with advanced skills to take on responsibilities that were previously considered to be the domain of doctors. In turn, that has freed doctors to focus more on the specifics of an intervention that require their attention. TAVI procedures however carry a mortality risk, and the responsibility for undertaking a successful TAVI procedure will always lie with a Cardiologist who has had the breadth of training to manage the various complications that may occur during or after a procedure. This requires years of training, and there is no short-cut, or substitute.

Cardiology trainees have the full support of BCIS as regards their career aspirations. Current trainees are the future leaders of structural heart programs and will determine the composition of those programmes. Trainee positions in structural heart disease in the UK are largely post-CCT and highly competitive, and are likely to remain so for the foreseeable future. Nearly all TAVI centres (including Leicester) have a dedicated structural heart fellowship. Those who do these fellowships get excellent training and will move on to Structural Heart jobs where they will be grateful for the expertise of highly skilled nurse practitioner colleagues.

There is going to be a need for significant expansion in Structural Heart training over the coming years and BCIS will be producing a statement on this subject later in the year, outlining the expected training route for undertaking TAVI and other Structural Heart procedures.

Prof. David Hildick-Smith, BCIS President, on behalf of BCIS Council