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PERFORMANCE OF THE HEART TEAM APPROACH IN DAILY CLINICAL PRACTICE IN HIGH-RISK PATIENTS WITH AORTIC STENOSIS
  • +19
  • Gabriela Tirado-Conte,
  • Carolina Espejo,
  • Luis Nombela-Franco,
  • Pilar Jiménez-Quevedo,
  • Javier Cobiella,
  • David Vivas,
  • Alberto De Agustin,
  • Angela McInerney,
  • Eduardo Pozo,
  • Pablo Salinas,
  • Iván Núñez-Gil,
  • Nieves Gonzalo,
  • Enrique Villagrán,
  • Alfonso de Hoyos,
  • Hernán Mejía-Rentería,
  • Fernando Macaya,
  • Manuel Carnero-Alcázar,
  • Isidre Vilacosta,
  • Antonio Fernández-Ortiz,
  • Javier Escaned,
  • Luis Maroto,
  • Carlos Macaya
Gabriela Tirado-Conte
Hospital Clínico San Carlos
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Carolina Espejo
Hospital Clínico San Carlos
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Luis Nombela-Franco
Hospital Clínico San Carlos
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Pilar Jiménez-Quevedo
Hospital Clínico San Carlos
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Javier Cobiella
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David Vivas
Hospital Clínico San Carlos
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Alberto De Agustin
Hospital Clínico San Carlos
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Angela McInerney
Hospital Clínico San Carlos
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Eduardo Pozo
Hospital Clínico San Carlos
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Pablo Salinas
Hospital Clínico San Carlos
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Iván Núñez-Gil
Hospital Clínico San Carlos
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Nieves Gonzalo
Hospital Clínico San Carlos
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Enrique Villagrán
Hospital Clínico San Carlos
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Alfonso de Hoyos
Hospital Clínico San Carlos
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Hernán Mejía-Rentería
Hospital Clínico San Carlos
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Fernando Macaya
Hospital Clínico San Carlos
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Manuel Carnero-Alcázar
Hospital Clínico San Carlos
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Isidre Vilacosta
Hospital Clínico San Carlos
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Antonio Fernández-Ortiz
Hospital Clínico San Carlos
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Javier Escaned
Hospital Clínico San Carlos
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Luis Maroto
Hospital Clínico San Carlos
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Carlos Macaya
Hospital Clínico San Carlos
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Abstract

Objectives: The Heart Team (HT) approach plays a key role in selecting the optimal treatment strategy for patients with aortic stenosis. Little is known about the HT decision process and its impact on outcomes. The aim of this study was to identify the factors associated with the HT decision, and evaluate clinical outcomes according to the treatment choice. Methods: The study included a total of 286 consecutive patients with aortic stenosis referred for discussion in the weekly HT meeting in a cardiovascular institute over 2 years. Patients were stratified according to the selected therapeutic approach: medical treatment (MT), surgical (SAVR) or transcatheter (TAVR) aortic valve replacement. Baseline characteristics involved in making a therapeutic choice were identified and a decision-making tree was built using CART 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 MT according to the Logistic EuroSCORE (< or ≥28, respectively). While among younger patients (<88 years), significant mitral regurgitation (≥grade III), frailty, STS score and estimated glomerular filtration rate were the most relevant factors influencing treatment allocation. One-year all-cause mortality was 16.6% in the invasive groups (TAVR 17.2%, SAVR 14.0%) and 68.7% in the MT arm. Conclusions: The HT decision was determined by well-recognized risk factors which were used to define a treatment decision algorithm. Future studies with younger and lower risk patients may identify new contributory factors which may alter the selection process and treatment choice.

Peer review status:IN REVISION

17 Aug 2020Submitted to Journal of Cardiac Surgery
20 Aug 2020Assigned to Editor
20 Aug 2020Submission Checks Completed
21 Aug 2020Reviewer(s) Assigned
30 Aug 2020Review(s) Completed, Editorial Evaluation Pending
31 Aug 2020Editorial Decision: Revise Major