title: Prognostic impact of decisions taken by the heart team in patients evaluated for transcatheter aortic valve implantation.
abstract: OBJECTIVE
  To analyze long-term survival and predictors of mortality in patients evaluated for transcatheter aortic valve implantation (TAVI) depending on the decision taken by the heart team.
  
  
  METHODS
  All patients with severe aortic stenosis and high surgical risk evaluated for TAVI between June 2008 and June 2012 were included. Patients were grouped according to the therapeutic strategy decided by the heart team. Mean follow-up was 16.6 months (maximum 55.3).
  
  
  RESULTS
  A total of 149 patients were evaluated: 79 were accepted for TAVI, 12 had no current indication for valve replacement and were deferred, 13 were redirected to conventional surgery and 45 received medical treatment. The evaluated patients had a mean age of 83.7 years and a mean EuroSCORE of 19.8±12.3. Median survival free from all-cause death was 34.7 months (95% CI 27.1-42.3) in the TAVI group, 47.4 months (95% CI 0-97.4) in the deferred intervention group, not available in the surgery group and 8.2 months (95% CI 5.6-10.9) in the medical treatment group (log-rank p<0.001). After multivariable adjustment, only treatment group remained as an independent predictor of mortality. Considering the TAVI group as the reference category, the adjusted hazard ratio for all-cause death was 0.70 (95% CI 0.24-2.04) for the deferred intervention group, 0.16 (95% CI 0.02-1.19) for the surgery group and 2.47 (95% CI 1.46-4.18) for the medical treatment group.
  
  
  CONCLUSIONS
  The decision taken by the heart team on potential candidates for TAVI has a decisive prognostic significance, as those who are unsuitable for any kind of valve replacement have a significantly higher mortality.
authors.affiliation: Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain. Electronic address: diegoiglesiasdelvalle@gmail.com.
authors.forename: Diego
authors.initials: D
authors.lastname: Iglesias
authors.affiliation: Hospital Clínico San Carlos, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Salinas
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Moreno
authors.affiliation: Hospital Clinico Universitario, Valencia, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: García-Blas
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Calvo
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Jiménez-Valero
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Sánchez-Recalde
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Galeote
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: José María
authors.initials: JM
authors.lastname: Mesa
authors.affiliation: Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Plaza
authors.affiliation: Hospital Universitario La Paz, Madrid, Spain.
authors.forename: José Luis
authors.initials: JL
authors.lastname: López-Sendón
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D000066491:Clinical Decision-Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018579:Patient Selection; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D065467:Transcatheter Aortic Valve Replacement
keywords: Aortic stenosis; Estenose aórtica; Implantação percutânea da válvula aórtica; Substituição cirúrgica da válvula aórtica; Surgical aortic valve replacement; Transcatheter aortic valve implantation