Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience

Cátia Costa; Rui Campante Teles; João Brito; José Pedro Neves; Henrique Mesquita Gabriel; Miguel Abecassis; Regina Ribeiras; João Abecasis; Tiago Nolasco; Maria da Conceição Furstenau; Nélson Vale; António Tralhão; Sérgio Madeira; João Mesquita; Carla Saraiva; Rita Calé; Manuel Almeida; Ana Aleixo; Miguel Mendes

doi:10.1016/j.repc.2016.11.015

Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience

Cátia Costa, Rui Campante Teles, João Brito, José Pedro Neves, Henrique Mesquita Gabriel, Miguel Abecassis, Regina Ribeiras, João Abecasis, Tiago Nolasco, Maria da Conceição Furstenau, Nélson Vale, António Tralhão, Sérgio Madeira, João Mesquita, Carla Saraiva, Rita Calé, Manuel Almeida, Ana Aleixo, Miguel Mendes

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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.

Original language	English
Pages (from-to)	809-818
Journal	Revista Portuguesa de Cardiologia
Volume	36
Issue number	11
Early online date	15 Nov 2017
DOIs	https://doi.org/10.1016/j.repc.2016.11.015
Publication status	Published - Nov 2017

Keywords

Surgical aortic valve replacement
Transcatheter aortic valve implantation
Válvula aórtica percutânea
Estenose aórtica grave
Heart Team
Severe aortic stenosis
Standardization
Standardização
Substituição valvular aórtica cirúrgica

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10.1016/j.repc.2016.11.015

1-s2.0-S0870255116302803-mainFinal published version, 1.44 MBLicence: CC BY-NC-ND

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Costa, C., Teles, R. C., Brito, J., Neves, J. P., Gabriel, H. M., Abecassis, M., Ribeiras, R., Abecasis, J., Nolasco, T., Furstenau, M. D. C., Vale, N., Tralhão, A., Madeira, S., Mesquita, J., Saraiva, C., Calé, R., Almeida, M., Aleixo, A., & Mendes, M. (2017). Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience. Revista Portuguesa de Cardiologia, 36(11), 809-818. https://doi.org/10.1016/j.repc.2016.11.015

@article{7034e1c298504439835c12002dd33fb8,

title = "Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience",

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.",

keywords = " Surgical aortic valve replacement, Transcatheter aortic valve implantation, V{\'a}lvula a{\'o}rtica percut{\^a}nea, Estenose a{\'o}rtica grave, Heart Team, Severe aortic stenosis, Standardization, Standardiza{\c c}{\~a}o, Substitui{\c c}{\~a}o valvular a{\'o}rtica cir{\'u}rgica",

author = "C{\'a}tia Costa and Teles, {Rui Campante} and Jo{\~a}o Brito and Neves, {Jos{\'e} Pedro} and Gabriel, {Henrique Mesquita} and Miguel Abecassis and Regina Ribeiras and Jo{\~a}o Abecasis and Tiago Nolasco and Furstenau, {Maria da Concei{\c c}{\~a}o} and N{\'e}lson Vale and Ant{\'o}nio Tralh{\~a}o and S{\'e}rgio Madeira and Jo{\~a}o Mesquita and Carla Saraiva and Rita Cal{\'e} and Manuel Almeida and Ana Aleixo and Miguel Mendes",

year = "2017",

month = nov,

doi = "10.1016/j.repc.2016.11.015",

language = "English",

volume = "36",

pages = "809--818",

journal = "Revista Portuguesa de Cardiologia",

issn = "0304-4750",

publisher = "Sociedade Portuguesa de Cardiologia | Elsevier",

number = "11",

}

Costa, C, Teles, RC, Brito, J, Neves, JP, Gabriel, HM, Abecassis, M, Ribeiras, R, Abecasis, J, Nolasco, T, Furstenau, MDC, Vale, N, Tralhão, A, Madeira, S, Mesquita, J, Saraiva, C, Calé, R, Almeida, M , Aleixo, A & Mendes, M 2017, 'Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience', Revista Portuguesa de Cardiologia, vol. 36, no. 11, pp. 809-818. https://doi.org/10.1016/j.repc.2016.11.015

TY - JOUR

T1 - Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation

T2 - Eight years of experience

AU - Costa, Cátia

AU - Teles, Rui Campante

AU - Brito, João

AU - Neves, José Pedro

AU - Gabriel, Henrique Mesquita

AU - Abecassis, Miguel

AU - Ribeiras, Regina

AU - Abecasis, João

AU - Nolasco, Tiago

AU - Furstenau, Maria da Conceição

AU - Vale, Nélson

AU - Tralhão, António

AU - Madeira, Sérgio

AU - Mesquita, João

AU - Saraiva, Carla

AU - Calé, Rita

AU - Almeida, Manuel

AU - Aleixo, Ana

AU - Mendes, Miguel

PY - 2017/11

Y1 - 2017/11

N2 - 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.

AB - 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.

KW - Surgical aortic valve replacement

KW - Transcatheter aortic valve implantation

KW - Válvula aórtica percutânea

KW - Estenose aórtica grave

KW - Heart Team

KW - Severe aortic stenosis

KW - Standardization

KW - Standardização

KW - Substituição valvular aórtica cirúrgica

U2 - 10.1016/j.repc.2016.11.015

DO - 10.1016/j.repc.2016.11.015

M3 - Article

C2 - 29153618

VL - 36

SP - 809

EP - 818

JO - Revista Portuguesa de Cardiologia

JF - Revista Portuguesa de Cardiologia

SN - 0304-4750

IS - 11

ER -

Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience

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