Performance of the heart team approach in daily clinical practice in high‐risk patients with aortic stenosis

Abstract

Objective: The heart team (HT) approach plays a key role in selecting the optimaltreatment strategy for patients with aortic stenosis (AS). However, little is knownabout the HT decision process and its impact on outcomes. The aim of this studywas to identify the factors associated with the HT decision and evaluate clinicaloutcomes according to the treatment choice.Methods: The study included a total of 286 consecutive patients with AS referred fordiscussion in the weekly HT meeting in a cardiovascular institute over 2 years.Patients were stratified according to the selected therapeutic approach: medicaltreatment (MT), surgical (SAVR), or transcatheter (TAVR) aortic valve replacement.Baseline characteristics involved in making a therapeutic choice were identified and adecision‐making tree was built using classification and regression tree methodology.Results: Based on HT discussion, 53 patients were assigned to SAVR, 210 to TAVR,and 23 to MT. Older patients (≥88 years old) were mainly assigned to TAVR or MTaccording to the logistic EuroSCORE (<or≥28, respectively). While among youngerpatients (<88 years), significant mitral regurgitation (≥grade III), frailty, Society ofThoracic Surgeons score, and estimated glomerular filtration rate were the mostrelevant factors influencing treatment allocation. One‐year all‐cause mortality was16.6% in the invasive groups (TAVR = 17.2%, SAVR = 14.0%) and 68.7% in theMT arm.Conclusion: The HT decision was determined by well‐recognized risk factors thatwere used to define a treatment decision algorithm. Future studies with younger andJ Card Surg. 2021;36:31–39. wileyonlinelibrary.com/journal/jocs © 2020 Wiley Periodicals LLC | 31Gabriela Tirado‐Conte and Carolina Espejo‐Paeres contributed equally to this study.lower‐risk patients may identify new contributory factors that may alter the selectionprocess and treatment choice.