Clinical impact of the heart team on the outcomes of surgical aortic valve replacement among octogenarians |
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| Affiliation: | 1. Department of Cardiac Surgery, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada;2. Department of Cardiology, Quebec Heart and Lung Institute, Laval University, Quebec City, Quebec, Canada;1. Division of Cardiothoracic Surgery, Department of Surgery, Clinical Research Unit, Emory University School of Medicine, Atlanta, Ga;2. Department of Biostatistics, Rollins School of Public Health, Emory University School of Medicine, Atlanta, Ga;1. Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex;2. Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex;3. Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex;1. Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan;2. Department of Internal Medicine, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan;3. Department of Cardiology, Linkou Medical Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan;4. Center for Big Data Analytics and Statistics, Linkou Medical Center, Chang Gung Memorial Hospital, Taoyuan City, Taiwan;1. Division of Cardiac Surgery, Northwestern University, Northwestern Memorial Hospital, Chicago, Illinois;2. Department of Preventative Medicine, Division of Biostatistics, Northwestern University, Chicago, Illinois;3. Bluhm Cardiovascular Institute Clinical Trials Unit, Northwestern University, Chicago, Illinois |
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| Abstract: | ObjectivesThe effectiveness of a multidisciplinary heart team in the management of patients with severe symptomatic aortic stenosis is unknown. This study evaluated the impact of a heart team on the outcomes of surgical aortic valve replacement in octogenarians.MethodsBetween May 2007 and January 2016, 528 patients aged 80 years or more were referred to our institutional heart team for a transcatheter aortic valve replacement. Among these, 101 were redirected to surgical aortic valve replacement (heart team group). These patients were compared with a surgical aortic valve replacement cohort (n = 506) without prior heart team screening (non-heart team group), taken from the same time period. Propensity score matching with bootstrap analysis was performed; 76 heart team patients were matched to 76 non-heart team patients. Early and late outcomes including survival and readmission for cardiovascular causes were compared.ResultsMatched subgroups were largely comparable; congestive heart failure and echocardiographic pulmonary hypertension were more prevalent in the heart team group. In-hospital mortality was significantly lower in the matched heart team group (0% vs 6.0%, bootstrap mean difference 6.0%, 95% confidence interval, 2.2-9.8). The risk of stroke, low cardiac output state, reexploration for bleeding, pneumonia, and prolonged ventilation was also significantly lower in the heart team group. There was no significant between-group difference regarding late survival (hazard ratio, 0.86, 95% confidence interval, 0.55-1.33, P = .49) or readmission for cardiovascular reasons (hazard ratio, 0.70, 95% confidence interval, 0.41-1.20, P = .19).ConclusionsPreoperative multidisciplinary assessment of octogenarians by a heart team was associated with lower in-hospital mortality and adverse events after surgical aortic valve replacement. |
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