Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center
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 foll...
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MDPI AG
2021
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oai:doaj.org-article:5a7e2c25643b4015b4ff265e5a531e192021-11-25T18:02:31ZHeart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center10.3390/jcm102254082077-0383https://doaj.org/article/5a7e2c25643b4015b4ff265e5a531e192021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5408https://doaj.org/toc/2077-0383Background: 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 (<i>p</i> < 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 (<i>p</i> < 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 (<i>p</i> < 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.Szymon JonikMichał MarchelEwa Pędzich-PlachaZenon HuczekJanusz KochmanPiotr ŚcisłoPaweł CzubRadosław WilimskiPiotr HendzelGrzegorz OpolskiMarcin GrabowskiTomasz MazurekMDPI AGarticleheart teamaortic stenosisheart failuretranscatheter aortic valve replacementsurgical aortic valve replacementoptimal medical therapyMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5408, p 5408 (2021) |
| institution |
DOAJ |
| collection |
DOAJ |
| language |
EN |
| topic |
heart team aortic stenosis heart failure transcatheter aortic valve replacement surgical aortic valve replacement optimal medical therapy Medicine R |
| spellingShingle |
heart team aortic stenosis heart failure transcatheter aortic valve replacement surgical aortic valve replacement optimal medical therapy Medicine R Szymon Jonik Michał Marchel Ewa Pędzich-Placha Zenon Huczek Janusz Kochman Piotr Ścisło Paweł Czub Radosław Wilimski Piotr Hendzel Grzegorz Opolski Marcin Grabowski Tomasz Mazurek Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center |
| description |
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 (<i>p</i> < 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 (<i>p</i> < 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 (<i>p</i> < 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. |
| format |
article |
| author |
Szymon Jonik Michał Marchel Ewa Pędzich-Placha Zenon Huczek Janusz Kochman Piotr Ścisło Paweł Czub Radosław Wilimski Piotr Hendzel Grzegorz Opolski Marcin Grabowski Tomasz Mazurek |
| author_facet |
Szymon Jonik Michał Marchel Ewa Pędzich-Placha Zenon Huczek Janusz Kochman Piotr Ścisło Paweł Czub Radosław Wilimski Piotr Hendzel Grzegorz Opolski Marcin Grabowski Tomasz Mazurek |
| author_sort |
Szymon Jonik |
| title |
Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center |
| title_short |
Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center |
| title_full |
Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center |
| title_fullStr |
Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center |
| title_full_unstemmed |
Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center |
| title_sort |
heart team for optimal management of patients with severe aortic stenosis—long-term outcomes and quality of life from tertiary cardiovascular care center |
| publisher |
MDPI AG |
| publishDate |
2021 |
| url |
https://doaj.org/article/5a7e2c25643b4015b4ff265e5a531e19 |
| work_keys_str_mv |
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| _version_ |
1718411680966246400 |