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Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative,

Peyman Sardari Nia1,2, Jules R Olsthoorn1, Samuel Heuts1

  • 1Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|March 30, 2021
PubMed

Insights

A dedicated heart team approach for mitral valve disease significantly improves patient survival compared to a general heart team. Following heart team recommendations, whether general or dedicated, also reduces mortality risk.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Outcomes

Background:

  • The heart team approach is a Class I recommendation in US and European guidelines for mitral valve disease.
  • However, supporting evidence for its comparative effectiveness is limited.
  • This study aimed to compare survival data between general and dedicated heart teams for mitral valve disease.

Purpose of the Study:

  • To compare the survival rates of patients with mitral valve disease managed by a general heart team versus a dedicated mitral valve heart team.
  • To evaluate the impact of adhering to heart team recommendations on patient mortality.

Main Methods:

  • Retrospective cohort study including 1145 patients evaluated for mitral valve disease.
  • Patients were divided into two groups: general heart team (2009-2014) and dedicated mitral valve heart team (2014-2018).
  • Decision-making was prospectively recorded, and overall survival was the primary endpoint.

Main Results:

  • The dedicated heart team group (n=641) showed a 5-year survival probability of 0.74, compared to 0.70 for the general heart team group (n=504) (P=0.040).
  • Patients managed by the dedicated heart team had a 29% lower adjusted risk of mortality (HR 0.71, P=0.019).
  • Adherence to dedicated heart team advice reduced mortality by 61%, while adherence to general heart team advice reduced it by 43%.

Conclusions:

  • Management of mitral valve disease by a dedicated heart team is associated with significantly higher survival rates.
  • These survival benefits are independent of treatment allocation, mitral valve pathology, and patient baseline characteristics.
  • Following heart team recommendations is crucial for improving survival in mitral valve disease patients.
Abstract

Keywords:
Heart teamMitral valve diseaseMultidisciplinary decision-making

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