Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis

Area of Science:

• Cardiology
• Interventional Cardiology
• Cardiac Surgery

Background:

• Severe aortic stenosis (AS) is a critical condition requiring timely intervention.
• Transcatheter aortic valve replacement (TAVR) has emerged as a key treatment modality.
• The impact of integrated TAVR programs and multidisciplinary heart teams on long-term outcomes requires further analysis.

Purpose of the Study:

• To evaluate the effect of establishing a transcatheter aortic valve replacement (TAVR) program and a multidisciplinary heart team on mortality rates in patients with severe aortic stenosis (AS).
• To compare outcomes between the pre- and post-TAVR implementation eras.

Main Methods:

• Retrospective observational cohort study utilizing echocardiography, cardiothoracic surgery, and TAVR databases (2006-2016).
• Inclusion of 3399 patients with echocardiographically defined severe AS.
• Analysis of all-cause mortality within 5 years, employing inverse probability weighting and Cox proportional hazards models.

Main Results:

• Overall 5-year mortality was 47.5%.
• Patients in the post-TAVR era were older with lower ejection fraction and more severe AS but fewer comorbidities.
• A significant mortality benefit was observed in the post-TAVR era (HR=0.86, p=0.015), which became more pronounced after matching for clinical factors (HR=0.82, p=0.001) and persisted after adjusting for intervention (HR=0.84, p=0.005).

Conclusions:

• Implementation of a TAVR program is associated with a significant mortality benefit for patients with severe AS.
• This benefit is independent of increased access to aortic valve intervention.
• Multidisciplinary TAVR programs contribute to improved survival in severe AS populations.