Cátia Costa1, Rui Campante Teles2, João Brito3, José Pedro Neves4, Henrique Mesquita Gabriel3, Miguel Abecassis4, Regina Ribeiras3, João Abecasis2, Tiago Nolasco4, Maria da Conceição Furstenau5, Nélson Vale3, António Tralhão3, Sérgio Madeira3, João Mesquita3, Carla Saraiva6, Rita Calé7, Manuel Almeida2, Ana Aleixo8, Miguel Mendes3. 1. Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; Serviço de Cardiologia, Hospital Santarém, Santarém, Portugal. Electronic address: ccatiasofia@sapo.pt. 2. Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; CEDOC, Nova Medical School, Lisboa, Portugal. 3. Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal. 4. Serviço de Cirurgia Cardiotorácica, Hospital Santa Cruz (CHLO), Carnaxide, Portugal. 5. Serviço de Anestesiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal. 6. Serviço de Imagiologia, Hospital S. Francisco Xavier (CHLO), Lisboa, Portugal. 7. Serviço de Cardiologia, Hospital Santa Cruz (CHLO), Carnaxide, Portugal; Serviço de Cardiologia, Hospital Garcia Orta, Almada, Portugal. 8. CEDOC, Nova Medical School, Lisboa, Portugal.
Abstract
INTRODUCTION: Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. METHODS: The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. RESULTS: TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients' outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). CONCLUSIONS: The heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner.
INTRODUCTION: Aortic stenosis is the most prevalent type of valvular disease in Europe. Surgical aortic valve replacement (SAVR) is the standard therapy, while transcatheter aortic valve implantation (TAVI) is an alternative in patients at unacceptably high surgical risk. Assessment by a heart team is recommended by the guidelines but there is little published evidence on this subject. The purpose of this paper is to describe the experience of a multidisciplinary TAVI program that began in 2008. METHODS: The heart team prospectively assessed 473 patients using a standardized approach. A total of 214 patients were selected for TAVI and 80 for SAVR. Demographic, clinical and procedural characteristics and long-term success rates were compared between the groups. RESULTS: TAVI patients were older than the SAVR group (median 83 vs. 81 years), and had higher surgical risk scores (median EuroSCORE II 5.3 vs. 3.6% and Society of Thoracic Surgeons score 5.1 vs. 3.1%), as did the patients under medical treatment only. These scores were unable to assess multiple comorbidities. Patients' outcomes were different between the three groups (mortality with SAVR 25% vs. TAVI 37.6% vs. conservative therapy 57.6%, p=0.001). CONCLUSIONS: The heart team program was able to select candidates appropriately for TAVI, SAVR and conservative treatment, taking into account the risk of both invasive treatments. The use of a prospective standardized heart team approach is recommended, but requires continuous monitoring to ensure effectiveness in a timely manner.
Authors: Dylan R Jones; Derek P Chew; Matthew J Horsfall; Anthony Ming-Yu Chuang; Ajay R Sinhal; Majo X Joseph; Robert A Baker; Jayme S Bennetts; Joseph B Selvanayagam; Sam J Lehman Journal: Open Heart Date: 2019-07-29
Authors: Christopher Strong; António Ferreira; Rui Campante Teles; Gustavo Mendes; João Abecasis; Gonçalo Cardoso; Sara Guerreiro; Pedro Freitas; Ana Coutinho Santos; Carla Saraiva; João Brito; Luís Raposo; Pedro de Araújo Gonçalves; Henrique Mesquita Gabriel; Manuel de Sousa Almeida; Miguel Mendes Journal: Sci Rep Date: 2019-12-27 Impact factor: 4.379