Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis

Hans Gustav Hørsted Thyregod; Fredrik Holmberg; Thomas Alexander Gerds; Nikolaj Ihlemann; Lars Søndergaard; Daniel Andreas Steinbrüchel; Peter Skov Olsen

doi:10.3109/14017431.2016.1148825

Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis

Hans Gustav Hørsted Thyregod, Fredrik Holmberg, Thomas Alexander Gerds, Nikolaj Ihlemann, Lars Søndergaard, Daniel Andreas Steinbrüchel, Peter Skov Olsen

6 Citationer (Scopus)

Abstract

Objectives After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design All adult patients with severe AVS referred to a large tertiary medical centre in 2011 were prospectively included. Multivariate regression analysis identified independent factors associated with treatment decisions. Results A total of 487 patients were included (mean age: 75 years, NYHA class III–IV: 47%). The HT proposed medical therapy (MT) in 35 (7%), TAVI in 60 (12%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09–1.26; p < 0.01) with more previous coronary artery bypass surgery (OR = 385, 79–2738; p < 0.01), obesity (OR = 4.69, 1.51–13.77; p < 0.01), and chronic obstructive pulmonary disease (COPD) (OR = 3.66, 1.21–10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease. Conclusions The HT proposed intervention in 93% of patients with severe AVS despite high age, advanced symptoms and a high burden of co-morbidity. TAVI was reserved for older patients particularly with previous CABG.

Originalsprog	Engelsk
Tidsskrift	Scandinavian Cardiovascular Journal
Vol/bind	50
Udgave nummer	3
Sider (fra-til)	146–153
Antal sider	8
ISSN	1401-7431
DOI	https://doi.org/10.3109/14017431.2016.1148825
Status	Udgivet - 3 maj 2016

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10.3109/14017431.2016.1148825

Citationsformater

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abstract = "Objectives After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design All adult patients with severe AVS referred to a large tertiary medical centre in 2011 were prospectively included. Multivariate regression analysis identified independent factors associated with treatment decisions. Results A total of 487 patients were included (mean age: 75 years, NYHA class III–IV: 47%). The HT proposed medical therapy (MT) in 35 (7%), TAVI in 60 (12%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09–1.26; p < 0.01) with more previous coronary artery bypass surgery (OR = 385, 79–2738; p < 0.01), obesity (OR = 4.69, 1.51–13.77; p < 0.01), and chronic obstructive pulmonary disease (COPD) (OR = 3.66, 1.21–10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease. Conclusions The HT proposed intervention in 93% of patients with severe AVS despite high age, advanced symptoms and a high burden of co-morbidity. TAVI was reserved for older patients particularly with previous CABG.",

author = "Thyregod, {Hans Gustav H{\o}rsted} and Fredrik Holmberg and Gerds, {Thomas Alexander} and Nikolaj Ihlemann and Lars S{\o}ndergaard and Steinbr{\"u}chel, {Daniel Andreas} and Olsen, {Peter Skov}",

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T1 - Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis

AU - Thyregod, Hans Gustav Hørsted

AU - Holmberg, Fredrik

AU - Gerds, Thomas Alexander

AU - Ihlemann, Nikolaj

AU - Søndergaard, Lars

AU - Steinbrüchel, Daniel Andreas

AU - Olsen, Peter Skov

PY - 2016/5/3

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N2 - Objectives After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design All adult patients with severe AVS referred to a large tertiary medical centre in 2011 were prospectively included. Multivariate regression analysis identified independent factors associated with treatment decisions. Results A total of 487 patients were included (mean age: 75 years, NYHA class III–IV: 47%). The HT proposed medical therapy (MT) in 35 (7%), TAVI in 60 (12%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09–1.26; p < 0.01) with more previous coronary artery bypass surgery (OR = 385, 79–2738; p < 0.01), obesity (OR = 4.69, 1.51–13.77; p < 0.01), and chronic obstructive pulmonary disease (COPD) (OR = 3.66, 1.21–10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease. Conclusions The HT proposed intervention in 93% of patients with severe AVS despite high age, advanced symptoms and a high burden of co-morbidity. TAVI was reserved for older patients particularly with previous CABG.

AB - Objectives After transcatheter aortic valve implantation (TAVI) has been available for high-risk patients with severe aortic valve stenosis (AVS), the decision-making of the Heart Team (HT) has not been examined. Design All adult patients with severe AVS referred to a large tertiary medical centre in 2011 were prospectively included. Multivariate regression analysis identified independent factors associated with treatment decisions. Results A total of 487 patients were included (mean age: 75 years, NYHA class III–IV: 47%). The HT proposed medical therapy (MT) in 35 (7%), TAVI in 60 (12%), and surgical aortic valve replacement (SAVR) in 392 (81%) of patients. In patients referred to intervention, TAVI compared with SAVR patients were older (OR = 1.17 per year, 95% CI 1.09–1.26; p < 0.01) with more previous coronary artery bypass surgery (OR = 385, 79–2738; p < 0.01), obesity (OR = 4.69, 1.51–13.77; p < 0.01), and chronic obstructive pulmonary disease (COPD) (OR = 3.66, 1.21–10.75; p = 0.02). MT patients compared with patients referred to any intervention were older, had a higher prevalence of COPD, peripheral arterial disease, previous myocardial infarction, and cerebrovascular disease. Conclusions The HT proposed intervention in 93% of patients with severe AVS despite high age, advanced symptoms and a high burden of co-morbidity. TAVI was reserved for older patients particularly with previous CABG.

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JO - Scandinavian Cardiovascular Journal, Supplement

JF - Scandinavian Cardiovascular Journal, Supplement

IS - 3

ER -

Heart Team therapeutic decision-making and treatment in severe aortic valve stenosis

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