Value Partnerships Update

June 2022

The Michigan Structural Heart Consortium expands focus to impact more Michigan patients

Transcatheter aortic valve replacement, or TAVR, also known as TAVI or transcatheter aortic valve implantation, is a procedure for patients with aortic stenosis, a narrowing of the aortic valve opening in the heart. TAVR delivers a fully collapsible bioprosthetic valve to the valve site through a catheter, rather than open heart surgery. TAVR initially provided an alternative for people who needed valve replacement but were considered high or inoperable risk for open heart surgery. Now, the minimally invasive approach is the first option for many people, regardless of risk. “Through shared decision- making, the heart team (including both cardiologists and surgeons) and the patient discuss goals of care and develop a life plan that makes sense for each patient,” said Michael Grossman, M.D., MISHC co-program director and interventional cardiologist at Michigan Medicine.

The Michigan TAVR consortium, convened in 2015, has long focused on supporting quality improvement related to TAVR procedures across Michigan, engaging with all 30 hospitals that have open heart surgery programs, and achieving significant in gains in goals affecting patients’ procedural experience and long-term quality of life.

Measure	Baseline	2021	% Change
Increase echocardiogram post-procedure	87.10%	99.20%	13.9%
Increase follow-up information at 30 days	85.40%	95.60%	11.9%
Decrease contrast use to prevent kidney injury	30.60%	3.50%	-88.6%
Decrease bleeding complications	4.50%	2.40%	-46.7%
Decrease blood transfusions	17.20%	5.80%	-66.3%

Himanshu Patel, M.D., consortium co-director and surgeon, points out that “collaboration among interventional cardiology and cardio-thoracic surgery teams, spearheaded through the collaborative model of Michigan TAVR, has been critical to the quality improvement achievements of our consortium.”

With the growing use of transcatheter mitral valve therapies (transcatheter edge-to-edge repair, or TEER, and transcatheter mitral valve replacement, or TMVR), Michigan TAVR is expanding its scope to include this important new area of quality improvement focus, and beginning in 2022, will report both TAVR and mitral procedure data to all Michigan hospitals, and convene stakeholders around data-driven QI initiatives, education and networking.

TEER - treats mitral regurgitation	TMVR - treats mitral stenosis/narrowing
When mitral regurgitation is severe, blood backs into lungs and leads to congestive heart failure. A TEER device involves clipping together a portion of the mitral valve leaflets as treatment for reducing mitral regurgitation, or MR.	Similar to TAVR, TMVR percutaneously delivers a collapsible bioprosthetic valve to valve site via a catheter. Both TEER and TMVR are performed mainly in patients who are at high or prohibitive surgical risk for open heart surgery.

“We are thrilled about this new chapter in our consortium and are excited for the opportunity to improve the quality of care and outcomes for patients as use of transcatheter mitral procedures grows in Michigan,” says Stanley Chetcuti, M.D., MISHC co-program director and interventional cardiologist at Michigan Medicine.

As part of this expanded scope, the consortium has also updated its name to the Michigan Structural Heart Consortium, or MISHC, to be more inclusive of the procedures on which it focuses and allow for future continued expansion. Additionally, MISHC has launched a new website, mishc.org, where you’ll find best practice protocols, a risk calculator, links to guidelines, and news and information about the consortium.

MISHC MISHC is a collaboration between the Michigan Society of Thoracic and Cardiovascular Surgeons Quality Collaborative, or MSTCVS-QC, and Blue Cross Blue Shield of Michigan Cardiovascular Consortium, or BMC2, both Collaborative Quality Initiatives, or CQIs, within Blue Cross Blue Shield of Michigan’s unique Value Partnerships program.

Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.