PERFORMANCE OF THE HEART TEAM APPROACH IN DAILY CLINICAL PRACTICE IN
HIGH-RISK PATIENTS WITH AORTIC STENOSIS
Abstract
Objectives: The Heart Team (HT) approach plays a key role in selecting
the optimal treatment strategy for patients with aortic stenosis. Little
is known about the HT decision process and its impact on outcomes. The
aim of this study was to identify the factors associated with the HT
decision, and evaluate clinical outcomes according to the treatment
choice. Methods: The study included a total of 286 consecutive patients
with aortic stenosis referred for discussion in the weekly HT meeting in
a cardiovascular institute over 2 years. Patients were stratified
according to the selected therapeutic approach: medical treatment (MT),
surgical (SAVR) or transcatheter (TAVR) aortic valve replacement.
Baseline characteristics involved in making a therapeutic choice were
identified and a decision-making tree was built using CART methodology.
Results: Based on HT discussion 53 patients were assigned to SAVR, 210
to TAVR and 23 to MT. Older patients (≥88-years-old) were mainly
assigned to TAVR or MT according to the Logistic EuroSCORE (<
or ≥28, respectively). While among younger patients (<88
years), significant mitral regurgitation (≥grade III), frailty, STS
score and estimated glomerular filtration rate were the most relevant
factors influencing treatment allocation. One-year all-cause mortality
was 16.6% in the invasive groups (TAVR 17.2%, SAVR 14.0%) and 68.7%
in the MT arm. Conclusions: The HT decision was determined by
well-recognized risk factors which were used to define a treatment
decision algorithm. Future studies with younger and lower risk patients
may identify new contributory factors which may alter the selection
process and treatment choice.