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

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

Research output: Contribution to journalArticle

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.

LanguageEnglish
Article numbere000983
JournalOpen Heart
Volume6
Issue number2
DOIs
Publication statusPublished - 1 Jul 2019
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Jones, D. R., Chew, D., Horsfall, M. J., Chuang, A. M. Y., Sinhal, A. R., Joseph, M. X., ... Lehman, S. J. (2019). Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis. Open Heart, 6(2), [e000983]. https://doi.org/10.1136/openhrt-2018-000983
Jones, Dylan R. ; Chew, Derek ; Horsfall, Matthew J. ; Chuang, Anthony Ming Yu ; Sinhal, Ajay R. ; Joseph, Majo X. ; Baker, Robert A. ; Bennetts, Jayme S. ; Selvanayagam, Joseph ; Lehman, Sam J. / Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis. In: Open Heart. 2019 ; Vol. 6, No. 2.
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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.",
keywords = "aortic stenosis, cardiovascular outcomes, multidisciplinary communication, surgical aortic valve replacement, transcatheter aortic valve replacement",
author = "Jones, {Dylan R.} and Derek Chew 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 Joseph Selvanayagam and Lehman, {Sam J.}",
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Jones, DR, Chew, D, Horsfall, MJ, Chuang, AMY, Sinhal, AR, Joseph, MX, Baker, RA, Bennetts, JS, Selvanayagam, J & Lehman, SJ 2019, 'Multidisciplinary transcatheter aortic valve replacement heart team programme improves mortality in aortic stenosis', Open Heart, vol. 6, no. 2, e000983. https://doi.org/10.1136/openhrt-2018-000983

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

In: Open Heart, Vol. 6, No. 2, e000983, 01.07.2019.

Research output: Contribution to journalArticle

TY - JOUR

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

AU - Jones, Dylan R.

AU - Chew, Derek

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

AU - Lehman, Sam J.

PY - 2019/7/1

Y1 - 2019/7/1

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

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JO - Open Heart

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