Prognostic impact of decisions taken by the heart team in patients evaluated for transcatheter aortic valve implantation.
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.


CONCLUSION
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.
['Iglesias|Diego|D|', 'Salinas|Pablo|P|', 'Moreno|Raúl|R|', 'García-Blas|Sergio|S|', 'Calvo|Luis|L|', 'Jiménez-Valero|Santiago|S|', 'Sánchez-Recalde|Ángel|Á|', 'Galeote|Guillermo|G|', 'Mesa|José María|JM|', 'Plaza|Ignacio|I|', 'López-Sendón|José Luis|JL|']
D000369:Aged, 80 and over D001024:Aortic Valve Stenosis 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
Transcatheter aortic valve implantation Aortic stenosis Estenose aórtica Implantação percutânea da válvula aórtica Substituição cirúrgica da válvula aórtica Surgical aortic valve replacement