Outcomes in Patients Undergoing Surgical Aortic Valve Replacement With Vs Without a Preoperative Heart Team Assessment

Overview

Journal CJC Open

Specialty Cardiology & Vascular Diseases

Date 2023 Jan 26

PMID 36700182

Authors

Julia Rodighiero

Ali M Alakhtar

Nouf Baker

Ali Zgheib

Benoit de Varennes

Kevin Lachapelle

Renzo Cecere

Patrick Ergina

Christo Tchervenkov

Dominique Shum-Tim

Giuseppe Martucci

Nicolo Piazza

Jonathan Afilalo

Marco Spaziano

Affiliations

Soon will be listed here.

Abstract

Background: This study sought to compare characteristics and outcomes of patients who underwent surgical aortic valve replacement (SAVR) after being referred to a heart team (HT), to those of patients referred directly for SAVR.

Methods: An analysis of patients who underwent SAVR from 2015 to 2020 was conducted. Patients were categorized into 3 groups, as follows: (i) H-HT: patients referred to the HT from 2015 to 2017 (historical cohort); (ii) C-HT: patients referred to the HT from 2018 to 2020 (contemporary cohort); and (iii) No-HT: patients referred directly to cardiac surgery from 2018 to 2020. Two subanalyses were performed: H-HT vs C-HT patients, and C-HT vs No-HT patients. The primary outcome was a composite of in-hospital mortality, prolonged intubation, reoperation, sternal wound infection, and stroke.

Results: This study consisted of 288 patients, distributed as follows: H-HT (n = 45); C-HT (n = 51); and No-HT (n = 192). The mean ages of H-HT, C-HT, and No-HT patients was 76.3 ± 6.9 years, 73.3 ± 7.6 years, and 69.6 ± 9.7 years, respectively ( = 0.0001). H-HT, C-HT, and No-HT patients had average Society of Thoracic Surgeons scores of 4.8 ± 2.2, 3.2 ± 1.6, and 4.2 ± 2 ( = 0.002), respectively. The composite outcome rate was more than 5 times higher among H-HT patients compared to that among the C-HT patients (20.0 vs 3.9%, = 0.02), and was numerically higher in No-HT compared to C-HT patients (13.0 vs 3.9%, = 0.07).

Conclusions: Referral to an HT appears to be primarily driven by higher chronological age rather than overall risk profile. Patients assessed by the HT prior to undergoing SAVR have a low incidence of complications, comparable to that among patients referred directly to cardiac surgery.

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