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

Dylan R. Jones; Derek P. Chew; Matthew J. Horsfall; Anthony Ming Yu Chuang; Ajay R. Sinhal; Majo X. Joseph; Robert A. Baker; Jayme S. Bennetts; Joseph B. Selvanayagam; Sam J. Lehman

doi:10.1136/openhrt-2018-000983

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

Dylan R. Jones, Derek P. Chew, Matthew J. Horsfall, Anthony Ming Yu Chuang, Ajay R. Sinhal, Majo X. Joseph, Robert A. Baker, Jayme S. Bennetts, Joseph B. Selvanayagam, Sam J. Lehman

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Abstract

Objectives To analyse the effect of the implementation of a transcatheter aortic valve replacement (TAVR) and multidisciplinary heart team programme on mortality in severe aortic stenosis (AS). Methods A retrospective, observational cohort study was performed using the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016. Outcomes were compared between the pre- and post-TAVR programme eras in a tertiary referral centre providing transcatheter and surgical interventions for AS. All-cause mortality within 5 years from diagnosis was determined for 3399 patients with echocardiographically defined severe AS. Results Of 3399 patients, there were 210 deaths (6.2%) at 30 days and 1614 deaths (47.5%) at 5 years. Overall, patients diagnosed in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS, but were less comorbid. Among 705 patients undergoing intervention, those in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS but no significant differences in comorbidities. Using an inverse probability weighted cohort and a Cox proportional hazards model, a significant mortality benefit was noted between eras alone (HR=0.86, 95% CI 0.77 to 0.97, p=0.015). When matching for age, comorbidities and valve severity, this benefit was more evident (HR=0.82, 95% CI 0.73 to 0.92, p=0.001). After adjusting for the presence of aortic valve intervention, a significant benefit persisted (HR=0.84, 95% CI 0.75 to 0.95, p=0.005). Conclusion The implementation of a TAVR programme is associated with a mortality benefit in the population with severe AS, independent of the expansion of access to intervention.

Original language	English
Article number	e000983
Number of pages	8
Journal	Open Heart
Volume	6
Issue number	2
DOIs	https://doi.org/10.1136/openhrt-2018-000983
Publication status	Published - 29 Jul 2019

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Keywords

aortic stenosis
cardiovascular outcomes
multidisciplinary communication
surgical aortic valve replacement
transcatheter aortic valve replacement

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title = "Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis",

abstract = "Objectives To analyse the effect of the implementation of a transcatheter aortic valve replacement (TAVR) and multidisciplinary heart team programme on mortality in severe aortic stenosis (AS). Methods A retrospective, observational cohort study was performed using the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016. Outcomes were compared between the pre- and post-TAVR programme eras in a tertiary referral centre providing transcatheter and surgical interventions for AS. All-cause mortality within 5 years from diagnosis was determined for 3399 patients with echocardiographically defined severe AS. Results Of 3399 patients, there were 210 deaths (6.2%) at 30 days and 1614 deaths (47.5%) at 5 years. Overall, patients diagnosed in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS, but were less comorbid. Among 705 patients undergoing intervention, those in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS but no significant differences in comorbidities. Using an inverse probability weighted cohort and a Cox proportional hazards model, a significant mortality benefit was noted between eras alone (HR=0.86, 95% CI 0.77 to 0.97, p=0.015). When matching for age, comorbidities and valve severity, this benefit was more evident (HR=0.82, 95% CI 0.73 to 0.92, p=0.001). After adjusting for the presence of aortic valve intervention, a significant benefit persisted (HR=0.84, 95% CI 0.75 to 0.95, p=0.005). Conclusion The implementation of a TAVR programme is associated with a mortality benefit in the population with severe AS, independent of the expansion of access to intervention.",

keywords = "aortic stenosis, cardiovascular outcomes, multidisciplinary communication, surgical aortic valve replacement, transcatheter aortic valve replacement",

author = "Jones, {Dylan R.} and Chew, {Derek P.} and Horsfall, {Matthew J.} and Chuang, {Anthony Ming Yu} and Sinhal, {Ajay R.} and Joseph, {Majo X.} and Baker, {Robert A.} and Bennetts, {Jayme S.} and Selvanayagam, {Joseph B.} and Lehman, {Sam J.}",

note = "This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.",

year = "2019",

month = jul,

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doi = "10.1136/openhrt-2018-000983",

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Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis. / Jones, Dylan R.; Chew, Derek P.; Horsfall, Matthew J.; Chuang, Anthony Ming Yu; Sinhal, Ajay R.; Joseph, Majo X.; Baker, Robert A.; Bennetts, Jayme S.; Selvanayagam, Joseph B.; Lehman, Sam J.

In: Open Heart, Vol. 6, No. 2, e000983, 29.07.2019.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis

AU - Jones, Dylan R.

AU - Chew, Derek P.

AU - Horsfall, Matthew J.

AU - Chuang, Anthony Ming Yu

AU - Sinhal, Ajay R.

AU - Joseph, Majo X.

AU - Baker, Robert A.

AU - Bennetts, Jayme S.

AU - Selvanayagam, Joseph B.

AU - Lehman, Sam J.

N1 - This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

PY - 2019/7/29

Y1 - 2019/7/29

N2 - Objectives To analyse the effect of the implementation of a transcatheter aortic valve replacement (TAVR) and multidisciplinary heart team programme on mortality in severe aortic stenosis (AS). Methods A retrospective, observational cohort study was performed using the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016. Outcomes were compared between the pre- and post-TAVR programme eras in a tertiary referral centre providing transcatheter and surgical interventions for AS. All-cause mortality within 5 years from diagnosis was determined for 3399 patients with echocardiographically defined severe AS. Results Of 3399 patients, there were 210 deaths (6.2%) at 30 days and 1614 deaths (47.5%) at 5 years. Overall, patients diagnosed in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS, but were less comorbid. Among 705 patients undergoing intervention, those in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS but no significant differences in comorbidities. Using an inverse probability weighted cohort and a Cox proportional hazards model, a significant mortality benefit was noted between eras alone (HR=0.86, 95% CI 0.77 to 0.97, p=0.015). When matching for age, comorbidities and valve severity, this benefit was more evident (HR=0.82, 95% CI 0.73 to 0.92, p=0.001). After adjusting for the presence of aortic valve intervention, a significant benefit persisted (HR=0.84, 95% CI 0.75 to 0.95, p=0.005). Conclusion The implementation of a TAVR programme is associated with a mortality benefit in the population with severe AS, independent of the expansion of access to intervention.

AB - Objectives To analyse the effect of the implementation of a transcatheter aortic valve replacement (TAVR) and multidisciplinary heart team programme on mortality in severe aortic stenosis (AS). Methods A retrospective, observational cohort study was performed using the echocardiography, cardiothoracic surgery and TAVR databases between 1 January 2006 and 31 December 2016. Outcomes were compared between the pre- and post-TAVR programme eras in a tertiary referral centre providing transcatheter and surgical interventions for AS. All-cause mortality within 5 years from diagnosis was determined for 3399 patients with echocardiographically defined severe AS. Results Of 3399 patients, there were 210 deaths (6.2%) at 30 days and 1614 deaths (47.5%) at 5 years. Overall, patients diagnosed in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS, but were less comorbid. Among 705 patients undergoing intervention, those in the post-TAVR programme era were older, with a lower ejection fraction and more severe AS but no significant differences in comorbidities. Using an inverse probability weighted cohort and a Cox proportional hazards model, a significant mortality benefit was noted between eras alone (HR=0.86, 95% CI 0.77 to 0.97, p=0.015). When matching for age, comorbidities and valve severity, this benefit was more evident (HR=0.82, 95% CI 0.73 to 0.92, p=0.001). After adjusting for the presence of aortic valve intervention, a significant benefit persisted (HR=0.84, 95% CI 0.75 to 0.95, p=0.005). Conclusion The implementation of a TAVR programme is associated with a mortality benefit in the population with severe AS, independent of the expansion of access to intervention.

KW - aortic stenosis

KW - cardiovascular outcomes

KW - multidisciplinary communication

KW - surgical aortic valve replacement

KW - transcatheter aortic valve replacement

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U2 - 10.1136/openhrt-2018-000983

DO - 10.1136/openhrt-2018-000983

M3 - Article

AN - SCOPUS:85070218745

VL - 6

JO - Open Heart

JF - Open Heart

SN - 2398-595X

IS - 2

M1 - e000983

ER -

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

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