title: Introduction of an interdisciplinary heart team-based transcatheter aortic valve implantation programme: short and mid-term outcomes.
abstract: BACKGROUND
  Transcatheter aortic valve implantation (TAVI) has been developed to treat symptomatic aortic stenosis in patients deemed too high risk for open-heart surgery. To address this complex population, an interdisciplinary heart team approach was proposed.
  
  
  OBJECTIVE
  Present the short- and mid-term outcomes of the first 100 patients in the Royal Prince Alfred Hospital multidisciplinary TAVI programme.
  
  
  METHODS
  Single-centre registry. Baseline and procedural data were prospectively recorded. Outcomes were recorded according to Valve Academic Research Consortium - version 2 guidelines.
  
  
  RESULTS
  All patients underwent a comprehensive interdisciplinary pre-procedural evaluation. Sixty-eight transfemoral and 32 transapical implantations were performed. Mean age was 82 (±8.9) years old with an average logistic EuroSCORE of 33. Although 13 procedures had major complications, there was no intraprocedural mortality. During the first month, 9% of patients were re-admitted due to heart failure and 13% had a permanent pacemaker implanted. A 3% 30-day and 8% follow-up (mean 17 months) mortalities were recorded. While no significant differences in the rate of complications were found between the first and second half of the experience, all cases of mortality within 30 days (n = 3) occurred in the initial half. Sustained haemodynamic results were obtained with TAVI (immediate mean aortic valve gradient reduction from 47 to 9 mmHg; 1-year echocardiographic gradient 9.9 mmHg, with no moderate or severe aortic regurgitation).
  
  
  CONCLUSIONS
  Excellent results can be achieved with TAVI in very high-risk patients at an Australian institution. A comprehensive evaluation based on a heart team can overcome most of the difficulties imposed by this challenging population.
authors: Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; Department of Cardiology, Catholic University School of Medicine, Santiago, Chile.
authors: G J
authors: GJ
authors: Martínez
authors: M
authors: M
authors: Seco
authors: S K
authors: SK
authors: Jaijee
authors: M R
authors: MR
authors: Adams
authors: B L
authors: BL
authors: Cartwright
authors: P
authors: P
authors: Forrest
authors: D S
authors: DS
authors: Celermajer
authors: M P
authors: MP
authors: Vallely
authors: M K
authors: MK
authors: Wilson
authors: M K C
authors: MK
authors: Ng
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001027:Aortography; D001315:Australia / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D016330:Frail Elderly / Q000706:statistics & numerical data*; D006801:Humans; D033183:Interdisciplinary Communication; D008297:Male; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome
keywords: aortic valve replacement; aortic valve stenosis; heart valve prosthesis; high-risk patient; transcatheter aortic valve implantation