Outcomes of Patients Discussed at the Multidisciplinary “Heart Team” Meeting According to Treatment Allocation

Abstract

Background: Transcatheter aortic valve implantation (TAVI) was introduced to Auckland City Hospital in 2011 for patients at high risk of mortality and morbidity from surgical aortic valve replacement (SAVR), as determined by a multidisciplinary “Heart Team” (MHT). Calculated surgical risk was a major consideration in the allocation process. Aim: To establish the outcomes and survival of aortic stenosis patients according to treatment allocation by the MHT. Method: Pertinent information relating to all patients discussed by the MHT was obtained from hospital records and the National Mortality Collection. Survival curves were constructed according to treatment allocation. Results: Between June 2011 and August 2016, 243 patients (mean age 80.2 years, 60% male) were presented at the MHT meeting. TAVI was recommended for 200, SAVR for 26 and medical therapy for 17 patients, with no significant difference in mean age in years (80.2, 80.4, 80.4, respectively) or EuroSCORE II (6.5, 5.3, and 6.7, respectively) between the three groups. Of the 188 patients who received TAVI 147 were transfemoral, 17 transapical and 24 transaortic. “As treated” survival curves (mean follow-up 2.0 years) are depicted (graph). Survival was similar between TAVI and SAVR with both being significantly longer than medical therapy survival p = 0.002 (93, 84 and 73% at one year and 85, 84 and 54% at two years respectively). Outcomes from TAVI and SAVR were similar to the general population. Conclusion: Mean survival of aortic stenosis patients who receive TAVI and SAVR is similar to the general population and longer than those who receive medical therapy alone.