Timeframe: life-long follow-up after hospital discharge for prosthetic valve implantation

Setting: outpatient setting, inpatient setting, and emergency department

Including:

initial assessment based on clinical history and physical examination

uncomplicated postoperative follow-up and management of complications

performance and interpretation of basic diagnostic modalities

interpretation of additional diagnostic modalities

medical therapy and endocarditis prophylaxis

Excluding: performing interventional or surgical therapy

• Medical expert

• Communicator

• Collaborator

• Leader

• Professional

• Describe the haemodynamics associated with normal function of the different types of prosthetic valve

• Discuss the issues to be considered in planning the follow-up of patients with prosthetic valves

• List the complications associated with prosthetic valves

• Explain the haemodynamics associated with the different forms of prosthetic valve dysfunction

• Discuss the aetiology of prosthetic valve dysfunction

• Describe the clinical signs of normal and dysfunctional prosthetic valves

• Summarise the course and prognosis of prosthetic valve diseases

• Describe the values and limitations of diagnostic modalities, in particular echocardiography

• Discuss the quantification of normal and abnormal prosthetic valve function

• Explain the indications, benefits, and risks of medical, interventional, and surgical therapy

• Detail the management of anticoagulant therapy in routine and special situations (e.g. PCI, non-cardiac surgery, pregnancy)

• Explain the current guidance on endocarditis prophylaxis

• Outline the measures required to optimize patient condition in preparation of interventional or surgical therapy

• Take a relevant history and perform an appropriate clinical examination

• Determine appropriate diagnostic modalities

• Perform and interpret the following diagnostic modalities:

  •   – ECG

  •   – Exercise ECG

  •   – Cardiopulmonary exercise testing

  •   – Transthoracic echocardiography

• Interpret the following diagnostic modalities:

  •   – Chest X-ray

  •   – Trans-oesophageal echocardiography

  •   – Stress echocardiography

  •   – Cardiac catheterization

  •   – Coronary angiography

  •   – Cardiac CT

  •   – Cardiac MR

  •   – Cardiac PET

• Decide on the follow-up strategy

• Determine, in association with the heart team, the indication for and timing of interventional or surgical therapy

• Discuss the benefits and risks of different therapeutic modalities according to patient characteristics

• Evaluate symptoms carefully using patient history and exercise testing

• Only apply the diagnostic modalities required for reaching a definitive diagnosis or for planning a therapeutic intervention

• Educate the patient about the durability of and risks associated with their prosthetic valve

• Iterate the importance of measures to reduce the endocarditis risk at every attendance

• Educate the patient on the natural history of prosthetic valve disease or dysfunction

• Ensure the patient understands the necessity for compliance with regular follow-up

• Provide balanced, understandable, and appropriate information to the patient on benefits and risks of different therapeutic modalities

• Involve the patient in all decisions relating to their management (shared decision-making)

• Commit to work in a Heart Team involving imaging specialists, interventional cardiologists, cardiac surgeons, anaesthetists, and nurses

• Direct observation/WBA (e.g. DOPS, Mini-CEX, fieldnotes)

• CbD (case-based discussion)/EbD (entrustment-based discussion

• 5. Able to teach (no supervision)