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OBJECTIVE: To review the experience of the heart team consisting of surgeon, cardiologist, anaesthetist and surgical care practitioner in managing patients with degenerative calcified aortic stenosis in a very active TransCatheter Aortic Valve Implantation (TAVI) centre.
METHODS: Since the TAVI programme was established in 2008, data of all patients referred to the programme was collected in a database. The TAVI Heart Team met twice per month and the outcomes of the patients treated by surgical aortic valve replacement (SAVR), TAVI or medical management alone were analysed. Kaplan-Meier survival analysis performed using SPSS 21.0.
RESULTS: In total 547 (M=282, F=265) patients were referred to the program. 248 underwent TAVI, while 78 had SAVR, and 171 had medical therapy. The mean age at operation for those having TAVI was 81±6.6 years, for SAVR 79±8 years and 83±9 years for medical therapy group. Mean waiting time for intervention was 14±9 months for TAVI and 10±6 months for SAVR. There were 17% deaths in the TAVI, 10.2% in SAVR and 34.5% in medical group. A further 39 patients died while awaiting definitive therapy. Mean survival is demonstrated in Fig 1. The mean time of death on the waiting list was 8.7±9.2 months with a mean logistic Euroscore of 18.2%±1.6
CONCLUSIONS: Those patients who underwent open AVR had longest mean survival time compared to those who underwent TAVI who, in turn, fared better than medical management. These results support the appropriate decisions of a Heart team process, but raise the concern of risk of sudden death in patients with severe aortic stenosis on a waiting list.