title: Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis.
abstract: Objectives After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design All adult patients with severe AVS referred to a large tertiary medical centre in 2011 were prospectively included. Multivariate regression analysis identified independent factors associated with treatment decisions. Results A total of 487 patients were included (mean age: 75 years, NYHA class III-IV: 47%). The HT proposed medical therapy (MT) in 35 (7%), TAVI in 60 (12%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09-1.26; p < 0.01) with more previous coronary artery bypass surgery (OR = 385, 79-2738; p < 0.01), obesity (OR = 4.69, 1.51-13.77; p < 0.01), and chronic obstructive pulmonary disease (COPD) (OR = 3.66, 1.21-10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease. Conclusions The HT proposed intervention in 93% of patients with severe AVS despite high age, advanced symptoms and a high burden of co-morbidity. TAVI was reserved for older patients particularly with previous CABG.
authors.affiliation: a Department of Cardiothoracic Surgery, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Hans Gustav Hørsted
authors.initials: HG
authors.lastname: Thyregod
authors.affiliation: a Department of Cardiothoracic Surgery, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Fredrik
authors.initials: F
authors.lastname: Holmberg
authors.affiliation: b Section for Biostatistics, Department of Public Health , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Thomas Alexander
authors.initials: TA
authors.lastname: Gerds
authors.affiliation: c Department of Cardiology, Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Nikolaj
authors.initials: N
authors.lastname: Ihlemann
authors.affiliation: c Department of Cardiology, Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Søndergaard
authors.affiliation: a Department of Cardiothoracic Surgery, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Daniel Andreas
authors.initials: DA
authors.lastname: Steinbrüchel
authors.affiliation: a Department of Cardiothoracic Surgery, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark ;
authors.forename: Peter Skov
authors.initials: PS
authors.lastname: Olsen
mesh_terms: D000367:Age Factors; D000368:Aged; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery; D000066491:Clinical Decision-Making / Q000379:methods; D015331:Cohort Studies; D015897:Comorbidity; D000072700:Conservative Treatment / Q000379:methods / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010347:Patient Care Planning / Q000458:organization & administration; D010348:Patient Care Team; D012720:Severity of Illness Index; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods / Q000706:statistics & numerical data
keywords: Aortic valve stenosis; Heart Team; surgical aortic valve replacement; therapeutic decision-making; transcatheter aortic valve implantation