Yonsei Med J.  2014 Sep;55(5):1246-1252. 10.3349/ymj.2014.55.5.1246.

Multidisciplinary Team Approach for Identifying Potential Candidate for Transcatheter Aortic Valve Implantation

• Hong SJ
• Hong MK
• Ko YG
• Choi D
• Hong GR
• Shim JK
• Kwak YL
• Lee S
• Chang BC
• Jang Y

• KMID: 1799487
• DOI: http://doi.org/10.3349/ymj.2014.55.5.1246

Abstract

PURPOSE
We sought to evaluate the clinical usefulness of decision making by a multidisciplinary heart team for identifying potential candidates for transcatheter aortic valve implantation (TAVI) in patients with symptomatic severe aortic stenosis.
MATERIALS AND METHODS
The multidisciplinary team consisted of two interventional cardiologists, two cardiovascular surgeons, one cardiac imaging specialist, and two cardiac anesthesiologists.
RESULTS
Out of 60 patients who were screened as potential TAVI candidates, 31 patients were initially recommended as appropriate for TAVI, and 20 of these 31 eventually underwent TAVI. Twenty-two patients underwent surgical aortic valve replacement (AVR), and 17 patients received only medical treatment. Patients who underwent TAVI and medical therapy were older than those who underwent surgical AVR (p<0.001). The logistic Euroscore was significantly highest in the TAVI group and lowest in the surgical AVR group (p=0.012). Most patients in the TAVI group (90%) and the surgical AVR group (91%) had severe cardiac symptoms, but only 47% in the medical therapy group had severe symptoms. The cumulative percentages of survival without re-hospitalization or all-cause death at 6 months for the surgical AVR, TAVI, and medical therapy groups were 84%, 75%, and 28%, respectively (p=0.007, by log-rank).
CONCLUSION
TAVI was recommended in half of the potential candidates following a multidisciplinary team approach and was eventually performed in one-third of these patients. One-third of the patients who were initially considered potential candidates received surgical AVR with favorable clinical outcomes.

Keyword

Endovascular procedures; aortic stenosis; clinical outcomes

MeSH Terms

Aged, 80 and over
Aortic Valve Stenosis/*surgery
Decision Making
Female
Humans
Male
*Patient Care Team
Postoperative Complications/epidemiology
Risk Factors
Severity of Illness Index
*Transcatheter Aortic Valve Replacement
Treatment Outcome

Figure

• 

  Fig. 1 Flow diagram of the multidisciplinary heart team approach. *Two patients offered medical therapy by multidisciplinary heart team because of moderate AS were excluded from outcome analysis. AVR, aortic valve replacement; CT, computed tomography; NYHA, New York Heart Association; TTE, trans-thoracic echocardiogram; TEE, trans-esophageal echocardiogram; TAVI, transcatheter aortic valve implantation.

• 

  Fig. 2 Kaplan-Meier survival curves for cumulative survival (A) and cumulative survival without rehospitalization or all-cause death (B). AVR, aortic valve replacement; TAVI, transcatheter aortic valve implantation.

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