1
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Wang X, Arslani K, Nuyens P, Montarello NJ, Vanhaverbeke M, Bieliauskas G, Sondergaard L, De Backer O. Contemporary guideline-directed management of patients with severe aortic valve stenosis. EUROINTERVENTION 2024; 20:e158-e167. [PMID: 38224253 PMCID: PMC10786179 DOI: 10.4244/eij-d-23-00469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 10/15/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are Class Ia recommended therapies for specific subgroups of severe aortic stenosis (AS) patients in the latest 2021 European guidelines. AIMS We aimed to report on the multidisciplinary Heart Team evaluation process and real-world practice of treating severe symptomatic AS in East Denmark in the context of the latest European guideline recommendations. METHODS All consecutive patients with severe AS referred for intervention in 2021 (N=672) were discussed in a multidisciplinary Heart Team meeting. All patients (100%) had a cardiac computed tomography (CT) analysis prior to the meeting. Baseline characteristics, Heart Team decision-making, final treatment and 30-day clinical outcomes were prospectively recorded. RESULTS The majority of severe AS patients (N=456, 68%) were referred for TAVI following discussion in the Heart Team. Ultimately, 94% of patients (N=632) received the Heart Team-recommended treatment. Patients undergoing TAVI (N=439) were significantly older (78.4±6.7 vs 67.2±8.3 years; p<0.001) and more comorbid than patients undergoing SAVR (N=189). The overall 30-day clinical outcomes were satisfactory for both treatment groups (overall 30-day mortality: 1.1%). The mean index hospitalisation length was markedly longer in the SAVR group (8.6±8.3 days) as compared to the TAVI group (1.8±3.2 days). CONCLUSIONS TAVI was routinely performed in low surgical risk patients in 2021 with two-thirds of all severe AS patients undergoing TAVI, thereby applying the latest European guidelines. A dedicated Heart Team meeting, including CT evaluation for all AS patients, is needed to make individualised management decisions in this new era of aortic valve interventions.
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Affiliation(s)
- Xi Wang
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Ketina Arslani
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Philippe Nuyens
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Nicholas J Montarello
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maarten Vanhaverbeke
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gintautas Bieliauskas
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Ole De Backer
- The Heart Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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2
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Burzotta F, Graziani F, Trani C, Aurigemma C, Bruno P, Lombardo A, Liuzzo G, Nesta M, Lanza GA, Romagnoli E, Locorotondo G, Leone AM, Pavone N, Spalletta C, Pelargonio G, Sanna T, Aspromonte N, Cavaliere F, Crea F, Massetti M. Clinical Impact of Heart Team Decisions for Patients With Complex Valvular Heart Disease: A Large, Single-Center Experience. J Am Heart Assoc 2022; 11:e024404. [PMID: 35621200 PMCID: PMC9238748 DOI: 10.1161/jaha.121.024404] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background A multidisciplinary approach might be pivotal for the management of patients with valvular heart disease (VHD), but clinical outcome data are lacking. Methods and Results At our institution, since 2014, internal guidelines recommended heart team consultations for patients with VHD. The clinical/echocardiographic characteristics, treatment recommendations, performed treatment, and early clinical outcomes of consecutive, hospitalized patients with VHD undergoing heart team evaluation were collected. Surgical risk was prospectively assessed by the EuroSCORE II and STS‐PROM. The primary end point of the study was early mortality. A total of 1004 patients with VHD with high clinical complexity (mean age, 75 years; mean EuroSCORE II, 9.4%; mean STS‐PROM, 5.6%; 48% ischemic heart disease; 29% chronic kidney disease, 9% oncologic/hematologic diseases) were enrolled. The heart team recommended an interventional treatment for 807 (80%) patients and conservative management for 197 (20%) patients. Management crossovers occurred in only 5% of patients. The recommended intervention was cardiac surgery for 230 (23%) patients, percutaneous treatment in 516 (51%) patients, and hybrid treatment in 61 (6%) patients. Early mortality occurred in 24 patients (2.4%) and was independently predicted by aortic stenosis, left ventricular ejection fraction, pulmonary artery systolic pressure, and conservative management recommendation. In patients referred to treatment, observed early mortality (1.7%) was significantly lower (P<0.001) than expected on the bases of both the STS‐PROM (5.2%) and EuroSCORE II (9.7%). Conclusions Within the limitations of its single‐center and observational design, the present study suggests that heart team–based management of patients with complex VHD is feasible and allows referral to a wide spectrum of interventions with promising early clinical results.
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Affiliation(s)
- Francesco Burzotta
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Carlo Trani
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Piergiorgio Bruno
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Antonella Lombardo
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Giovanna Liuzzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Marialisa Nesta
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | - Gaetano Antonio Lanza
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Enrico Romagnoli
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia
| | | | | | - Natalia Pavone
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | | | - Gemma Pelargonio
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Tommaso Sanna
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Nadia Aspromonte
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Franco Cavaliere
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Filippo Crea
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
| | - Massimo Massetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italia.,Università Cattolica del Sacro Cuore Roma Italia
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3
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Jonik S, Marchel M, Huczek Z, Kochman J, Wilimski R, Kuśmierczyk M, Grabowski M, Opolski G, Mazurek T. An Individualized Approach of Multidisciplinary Heart Team for Myocardial Revascularization and Valvular Heart Disease—State of Art. J Pers Med 2022; 12:jpm12050705. [PMID: 35629130 PMCID: PMC9144508 DOI: 10.3390/jpm12050705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 12/04/2022] Open
Abstract
The multidisciplinary Heart Team (HT) remains the standard of care for highly-burdened patients with coronary artery disease (CAD) and valvular heart disease (VHD) and is widely adopted in the medical community and supported by European and American guidelines. An approach of highly-experienced specialists, taking into account numerous clinical factors, risk assessment, long-term prognosis and patients preferences seems to be the most rational option for individuals with. Some studies suggest that HT management may positively impact adherence to current recommendations and encourage the incorporation of patient preferences through the use of shared-decision making. Evidence from randomized-controlled trials are scarce and we still have to satisfy with observational studies. Furthermore, we still do not know how HT should cooperate, what goals are desired and most importantly, how HT decisions affect long-term outcomes and patient’s satisfaction. This review aimed to comprehensively discuss the available evidence establishing the role of HT for providing optimal care for patients with CAD and VHD. We believe that the need for research to recognize the HT definition and range of its functioning is an important issue for further exploration. Improved techniques of interventional cardiology, minimally-invasive surgeries and new drugs determine future perspectives of HT conceptualization, but also add new issues to the complexity of HT cooperation. Regardless of which direction HT has evolved, its concept should be continued and refined to improve healthcare standards.
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Affiliation(s)
- Szymon Jonik
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
- Correspondence: ; Tel.: +48-22-599-19-58; Fax: +48-22-599-19-57
| | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (R.W.); (M.K.)
| | - Mariusz Kuśmierczyk
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (R.W.); (M.K.)
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
| | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (M.M.); (Z.H.); (J.K.); (M.G.); (G.O.); (T.M.)
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4
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Jonik S, Marchel M, Pędzich-Placha E, Huczek Z, Kochman J, Ścisło P, Czub P, Wilimski R, Hendzel P, Opolski G, Grabowski M, Mazurek T. Heart Team for Optimal Management of Patients with Severe Aortic Stenosis-Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center. J Clin Med 2021; 10:jcm10225408. [PMID: 34830690 PMCID: PMC8623928 DOI: 10.3390/jcm10225408] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: This retrospective study was proposed to investigate outcomes of patients with severe aortic stenosis (AS) after implementation of various treatment strategies following dedicated Heart Team (HT) decisions. Methods: Primary and secondary endpoints and quality of life during a median follow-up of 866 days of patients with severe AS qualified after HT discussion to: optimal medical treatment (OMT) alone, OMT and transcather aortic valve replacement (TAVR) or OMT and surgical aortic valve replacement (SAVR) were evaluated. As the primary endpoint composite of all-cause mortality, non-fatal disabling strokes and non-fatal rehospitalizations for AS were considered, while other clinical outcomes were determined as secondary endpoints. Results: From 2016 to 2019, 176 HT meetings were held, and a total of 482 participants with severe AS and completely implemented HT decisions (OMT, TAVR and SAVR for 79, 318 and 85, respectively) were included in the final analysis. SAVR and TAVR were found to be superior to OMT for primary and all secondary endpoints (p < 0.05). Comparing interventional strategies only, TAVR was associated with reduced risk of acute kidney injury, new onset of atrial fibrillation and major bleeding, while the superiority of SAVR for major vascular complications and need for permanent pacemaker implantation was observed (p < 0.05). The quality of life assessed at the end of follow-up was significantly better for patients who underwent TAVR or SAVR than in OMT-group (p < 0.05). Conclusions: We demonstrated that after careful implementation of HT decisions interventional strategies compared to OMT only provide superior outcomes and quality of life for patients with AS.
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Affiliation(s)
- Szymon Jonik
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
| | - Michał Marchel
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
- Correspondence: ; Tel.: +48-22-599-19-58; Fax: +48-22-599-19-57
| | - Ewa Pędzich-Placha
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
| | - Zenon Huczek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
| | - Janusz Kochman
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
| | - Piotr Ścisło
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
| | - Paweł Czub
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (P.C.); (R.W.); (P.H.)
| | - Radosław Wilimski
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (P.C.); (R.W.); (P.H.)
| | - Piotr Hendzel
- Department of Cardiac Surgery, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (P.C.); (R.W.); (P.H.)
| | - Grzegorz Opolski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
| | - Marcin Grabowski
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
| | - Tomasz Mazurek
- 1st Department of Cardiology, Medical University of Warsaw, Banacha 1a Str., 01-267 Warsaw, Poland; (S.J.); (E.P.-P.); (Z.H.); (J.K.); (P.Ś.); (G.O.); (M.G.); (T.M.)
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5
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Ying L, Chih N. Is Conventional Predictive Risk Modelling for Surgical Aortic Valve Replacement Still Relevant in This Minimally Invasive Era? J Cardiothorac Vasc Anesth 2021; 35:3557-3558. [PMID: 34625354 DOI: 10.1053/j.jvca.2021.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Li Ying
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore
| | - Nian Chih
- Department of Anaesthesiology, Singapore General Hospital, Singapore; Department of Cardiothoracic Anaesthesia, National Heart Centre, Singapore.
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6
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Dourado LOC, Pereira AC, Poppi NT, Cavalcante R, Gaiotto F, Dallan LAO, Bittencourt MS, Cesar LAM, Gowdak LHW. The Role of the Heart Team in Patients with Diffuse Coronary Artery Disease Undergoing Coronary Artery Bypass Grafting. Thorac Cardiovasc Surg 2020; 69:584-591. [PMID: 33225435 DOI: 10.1055/s-0040-1718936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In patients eligible for coronary artery bypass grafting, no data assess the importance of the Heart Team in programming the best surgical strategy for patients with diffuse coronary artery disease (CAD). This study aims to determine the contribution of the Heart Team in predicting the feasibility of coronary artery bypass graft and angiographic surgical success in these patients based on visual angiographic analysis. METHODS Patients with diffuse and severe CAD undergoing incomplete coronary artery bypass graft surgery were prospectively included. One-year postoperative coronary angiograms were obtained to evaluate graft occlusion. Two clinical cardiologists, two cardiovascular surgeons, and one interventional cardiologist retrospectively analyzed preoperative angiograms. A subjective scale was applied at a single moment to quantify the chance of successful coronary artery bypass grafting for each coronary territory with anatomical indication for revascularization. Based on individual scores, the Heart Team's and the specialists' scores were calculated and compared. RESULTS The examiners evaluated 154 coronary territories, of which 85 (55.2%) were protected. The Heart Team's accuracy for predicting the angiographic success of the surgery was 74.9%, almost equal to that of the surgeons alone (73.2%). Only the interventional cardiologist predicted left anterior descending territory grafting success. The Heart Team had good specificity and reasonable sensitivity, and the surgeons had high sensitivity and low specificity in predicting angiographic success. CONCLUSION The multispecialty Heart Team achieved good accuracy in predicting the angiographic coronary artery bypass graft success in patients with diffuse CAD, with a high specificity and reasonable sensitivity.
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Affiliation(s)
| | - Alexandre C Pereira
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Nilson Tavares Poppi
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Rafael Cavalcante
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Fabio Gaiotto
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | | | - Marcio Sommer Bittencourt
- Division of Internal Medicine, Center for Clinical and Epidemiological Research, University Hospital, University of São Paulo, Sao Paulo, Brazil
| | - Luiz Antonio M Cesar
- Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
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7
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Zhu S, Li H, Zhang G, Liu S, Li Z. Comparison of outcome of transcatheter aortic valve implantation in patients with advanced age: A systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e21443. [PMID: 32756159 PMCID: PMC7402761 DOI: 10.1097/md.0000000000021443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) is an effective treatment to aortic stenosis in patients with advanced age. However, age is recognized as one of the most important risk factors. The aim of our study is to compare the outcome of TAVI between octogenarian patients and young patients. METHODS Randomized controlled trials, cohort studies and propensity score matching studies will be included in our systematic review and meta-analysis to evaluate clinical outcome in octogenarian patients who undergo TAVI. PubMed, EMBASE, MEDLINE, Cochrane Library and Web of Science will be searched using a comprehensive strategy. The related conference proceedings and reference lists of the included studies will also be checked to identify additional studies. Retrieved records, extract information and assess the risk of bias will be screened by two reviewers independently. STATA software will be used to conduct data synthesis. There is no requirement of ethical approval and informed consent. RESULTS This study will eventually be published in a peer reviewed journal in the form of a scientific paper. CONCLUSION This study will provide a comprehensive review of the available evidence for the treatment of aortic stenosis in octogenarian patients underwent TAVI. We hope it will provide a relatively comprehensive reference for clinical practice and future relevant clinical trials. PROSPERO REGISTRATION NUMBER CRD42020155189. STUDY PROTOCOL REGISTRY The protocol has been registered in PROSPERO, which is an International Prospective Register of Systematic Reviews. The registration number is CRD42020155189. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required as this study is a systematic review and meta-analysis.
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Affiliation(s)
- Shengde Zhu
- First Clinical Medical College, Lanzhou University
| | - Han Li
- First Clinical Medical College, Lanzhou University
| | | | - Shidong Liu
- First Clinical Medical College, Lanzhou University
| | - Zijian Li
- Department of Hematology, First Hospital of Lanzhou University, Lanzhou, China
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8
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The learning curve in transcatheter aortic valve implantation clinical studies: A systematic review. Int J Technol Assess Health Care 2020; 36:152-161. [DOI: 10.1017/s0266462320000100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BackgroundTranscatheter aortic-valve implantation (TAVI) has become an essential alternative to surgical aortic-valve replacement in the treatment of symptomatic severe aortic stenosis, and this procedure requires technical expertise. The aim of this study was to identify prospective studies on TAVI from the past 10 years, and then to analyze the quality of information reported about the learning curve.Materials and methodsA systematic review of articles published between 2007 and 2017 was performed using PubMed and the EMBASE database. Prospective studies regarding TAVI were included. The quality of information reported about the learning curve was evaluated using the following criteria: mention of the learning curve, the description of a roll-in phase, the involvement of a proctor, and the number of patients suggested to maintain skills.ResultsA total of sixty-eight studies met the selection criteria and were suitable for analysis. The learning curve was addressed in approximately half of the articles (n = 37, 54 percent). However, the roll-in period was mentioned by only eight studies (12 percent) and with very few details. Furthermore, a proctorship was disclosed in three articles (4 percent) whereas twenty-five studies (37 percent) included authors that were proctors for manufacturers of TAVI.ConclusionMany prospective studies on TAVI over the past 10 years mention learning curves as a core component of successful TAVI procedures. However, the quality of information reported about the learning curve is relatively poor, and uniform guidance on how to properly assess the learning curve is still missing.
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9
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Burlacu A, Covic A, Cinteza M, Lupu PM, Deac R, Tinica G. Exploring Current Evidence on the Past, the Present, and the Future of the Heart Team: A Narrative Review. Cardiovasc Ther 2020; 2020:9241081. [PMID: 31969934 PMCID: PMC6964708 DOI: 10.1155/2020/9241081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 12/19/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Including healthcare professionals dealing with cardiovascular diseases, Heart Team is a concept/structure designed for selecting diagnostic strategies, facilitating therapeutic decisions, and improving cardiovascular outcomes in patients with complex heart pathologies, requiring input from different subspecialties and the necessity of a multidisciplinary approach. The aim of this narrative review is to search for and to summarize current evidence regarding Heart Team and to underline the future directions for the development of this concept. METHODS We searched the electronic database of PubMed, SCOPUS, and Cochrane CENTRAL for studies including Heart Team. Forty-eight studies were included, if reference was made to Heart Team structure and functionality. RESULTS We depicted the structure and the timeline of Heart Team, along with actual evidence-based recommendations from European Guidelines. We underlined the importance of quality of knowledge-sharing and decision-making inside the Team, analyzing bad decisions which did not reflect members' true beliefs due to "uniformity pressure, closed mindedness, and illusion of invulnerability." The observation that Guidelines' indications regarding Heart Team carry a level C indication underlines the very future of this Team: randomized controlled trials proving solid benefits in an evidence-based world. CONCLUSIONS Envisioned as a tool for optimizing the management of various complex cardiovascular pathologies, Heart Team should simplify and facilitate the activity in the cardiovascular ward. Finally, these facts should be translated into better cardiovascular outcomes and a lower psychological distress among Team participants. Despite all future changes, there must always be a constant part: the patient should remain at the very center of the Team.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
| | - Adrian Covic
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center, “C.I. Parhon” University Hospital, Iasi, Romania
- The Academy of Romanian Scientists (AOSR), Bucharest, Romania
| | - Mircea Cinteza
- Department of Cardiology, Emergency University Hospital, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Radu Deac
- The Romanian Academy of Medical Sciences, Bucharest, Romania
| | - Grigore Tinica
- “Grigore T. Popa” University of Medicine and Pharmacy, Iasi, Romania
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania
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10
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Kolbe M, Grande B, Marty A, Manka R, Taramasso M, Nietlispach F, Pomar JL, Maisano F, Reser D. Making Heart Team Discussions Work. STRUCTURAL HEART 2019. [DOI: 10.1080/24748706.2019.1572254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Michaela Kolbe
- Simulation Center, University Hospital Zurich, Switzerland
- ETH Zurich, Switzerland
| | - Bastian Grande
- Simulation Center, University Hospital Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Adrian Marty
- Simulation Center, University Hospital Zurich, Switzerland
- Institute of Anesthesiology, University Hospital Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, Heart Center, University Hospital Zurich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, Heart Center, University Hospital Zurich, Switzerland
| | - Jose Luis Pomar
- Hospital Clinico de Barcelona, University of Barcelona, Spain
| | - Francesco Maisano
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
| | - Diana Reser
- Department of Cardiovascular Surgery, Heart Center, University Hospital Zurich, Switzerland
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Zheng Y, Li T. Association between transcatheter aortic valve implantation or replacement and mortality, and major adverse events after coronary artery bypass grafting. IJC HEART & VASCULATURE 2018; 21:57-63. [PMID: 30310852 PMCID: PMC6178209 DOI: 10.1016/j.ijcha.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/29/2018] [Accepted: 08/22/2018] [Indexed: 11/09/2022]
Abstract
Background In recent years, many people are opting for minimally invasive surgery in China. Patients undergoing transcatheter aortic valve implantation or replacement (TAVIR) with previous coronary artery bypass grafting (CABG) have higher risks of death and major complications. Materials/methods PubMed and Embase were searched for all comparison studies between TAVIR with and without prior CABG and mortality as a primary outcome, irrespective of surgical risk, to investigate whether patients with prior CABG can undergo TAVIR. Randomized controlled trials and propensity-score-matched cohort studies were eligible for inclusion. The outcomes of interest included 30-day, 6-month, and 1-year mortality and 30-day complications. If significant heterogeneity was found in the random-effects meta-analyses, a sensitivity analysis that individually removed each study was conducted. Results Five studies reported results on patients undergoing TAVIR with or without prior CABG. Compared with the non-CABG cohort, the CABG cohort showed no significant difference in the 30-day, 6-month, and 1-year mortality and the 30-day risk of major complications, except life-threatening bleeding. However, for the 30-day risk of life-threatening bleeding, the morbidity of CABG cohort was significantly lower than that of the non-CABG cohort (risk ratio 0.555; 95% confidence interval 0.35–0.85; P = 0.006; I2 = 0%). Conclusions Patients with prior CABG can undergo TAVIR. Patients undergoing TAVIR without prior CABG need more attention because of a higher risk of life-threatening bleeding.
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Affiliation(s)
- Yue Zheng
- The Third Central Clinical College of Tianjin Medical University, Tianjin 300170, China.,Tianjin Key Laboratory of Artificial Cell, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
| | - Tong Li
- The Third Central Hospital of Tianjin, 83 Jintang Road, Hedong District, Tianjin 300170, China.,Tianjin Key Laboratory of Artificial Cell, China.,Artificial Cell Engineering Technology Research Center of Public Health Ministry, Tianjin, China.,Tianjin Institute of Hepatobiliary Disease, Tianjin, China
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Antonides CFJ, Mack MJ, Kappetein AP. Approaches to the Role of The Heart Team in Therapeutic Decision Making for Heart Valve Disease. STRUCTURAL HEART 2017. [DOI: 10.1080/24748706.2017.1380377] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Christiaan F. J. Antonides
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center Rotterdam, Thoraxcentrum, Rotterdam, The Netherlands
| | - Michael J. Mack
- Baylor Scott and White Healthcare System, Baylor University Medical Center, Baylor Heart and Vascular Hospital, Dallas, Texas, USA
- The Heart Hospital Baylor Plano, Plano, Texas, USA
| | - A. Pieter Kappetein
- Department of Cardio-Thoracic Surgery, Erasmus University Medical Center Rotterdam, Thoraxcentrum, Rotterdam, The Netherlands
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Auensen A, Hussain AI, Bendz B, Aaberge L, Falk RS, Walle-Hansen MM, Bye J, Andreassen J, Beitnes JO, Rein KA, Pettersen KI, Gullestad L. Morbidity outcomes after surgical aortic valve replacement. Open Heart 2017; 4:e000588. [PMID: 28674629 PMCID: PMC5471875 DOI: 10.1136/openhrt-2017-000588] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 01/11/2017] [Accepted: 01/17/2017] [Indexed: 11/16/2022] Open
Abstract
Objective In patients with mild to moderate operative risk, surgical aortic valve replacement (SAVR) is still the preferred treatment for patients with severe symptomatic aortic stenosis (AS). Aiming to broaden the knowledge of postsurgical outcomes, this study reports a broad set of morbidity outcomes following surgical intervention. Methods Our cohort comprised 442 patients referred for severe AS; 351 had undergone SAVR, with the remainder (91) not operated on. All patients were evaluated using the 6-minute walk test (6MWT), were assigned a New York Heart Association class (NYHA) and Canadian Cardiovascular Society class (CCS), with additional scores for health-related quality of life (HRQoL), cognitive function (Mini-Mental State Examination (MMSE)) and myocardial remodelling (at inclusion and at 1-year follow-up). Adverse events and mortality were recorded. Results Three-year survival after SAVR was 90.0%. SAVR was associated with an improved NYHA class, CCS score and HRQoL, and provoked reverse ventricular remodelling. The 6MWT decreased, while the risks of major adverse cardiovascular events (death, non-fatal stroke/transient ischaemic attack or myocardial infarction) and all-cause hospitalisation (incidence rate per 100 patient-years) were 13.5 and 62.4, respectively. The proportion of cognitive disability measured by MMSE increased after SAVR from 3.2% to 8.8% (p=0.005). Proportion of patients living independently at home, having attained NYHA class I, was met by 49.1% at 1 year. Unoperated individuals had a poor prognosis in terms of any outcome. Conclusion This study provides knowledge of outcomes beyond what is known about the mortality benefit after SAVR to provide insight into the morbidity burden of modern-day SAVR.
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Affiliation(s)
- Andreas Auensen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | - Bjørn Bendz
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | | | | | - Jorun Bye
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johanna Andreassen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Jan Otto Beitnes
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kjell Arne Rein
- Department of Cardiothoracic Surgery, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Kjell Ingar Pettersen
- Department of Cardiology, Faculty of Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital Rikshospitalet, Oslo, Norway
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