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Jones DR, Chew DP, Horsfall MJ, Chuang AMY, Sinhal AR, Joseph MX, Baker RA, Bennetts JS, Selvanayagam JB, Lehman SJ. Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis. Open Heart 2019; 6:e000983. [PMID: 31413842 PMCID: PMC6667939 DOI: 10.1136/openhrt-2018-000983] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 04/03/2019] [Accepted: 04/14/2019] [Indexed: 12/24/2022] Open
Abstract
Objectives To analyse the effect of the implementation of a transcatheter aortic valve replacement (TAVR) and multidisciplinary heart team programme on mortality in severe aortic stenosis (AS). Methods A retrospective, observational cohort study was performed using the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016. Outcomes were compared between the pre- and post-TAVR programme eras in a tertiary referral centre providing transcatheter and surgical interventions for AS. All-cause mortality within 5 years from diagnosis was determined for 3399 patients with echocardiographically defined severe AS. Results Of 3399 patients, there were 210 deaths (6.2%) at 30 days and 1614 deaths (47.5%) at 5 years. Overall, patients diagnosed in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS, but were less comorbid. Among 705 patients undergoing intervention, those in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS but no significant differences in comorbidities. Using an inverse probability weighted cohort and a Cox proportional hazards model, a significant mortality benefit was noted between eras alone (HR=0.86, 95% CI 0.77 to 0.97, p=0.015). When matching for age, comorbidities and valve severity, this benefit was more evident (HR=0.82, 95% CI 0.73 to 0.92, p=0.001). After adjusting for the presence of aortic valve intervention, a significant benefit persisted (HR=0.84, 95% CI 0.75 to 0.95, p=0.005). Conclusion The implementation of a TAVR programme is associated with a mortality benefit in the population with severe AS, independent of the expansion of access to intervention.
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Affiliation(s)
- Dylan R Jones
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Derek P Chew
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Matthew J Horsfall
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Anthony Ming-Yu Chuang
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Ajay R Sinhal
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Majo X Joseph
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Robert A Baker
- Cardiac and Thoracic Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Jayme S Bennetts
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.,Cardiac and Thoracic Surgery, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Joseph B Selvanayagam
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sam J Lehman
- Cardiology, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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