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Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center

Background: This retrospective study was proposed to investigate outcomes of patients with severe aortic stenosis (AS) after implementation of various treatment strategies following dedicated Heart Team (HT) decisions. Methods: Primary and secondary endpoints and quality of life during a median foll...

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Autores principales: Jonik, Szymon, Marchel, Michał, Pędzich-Placha, Ewa, Huczek, Zenon, Kochman, Janusz, Ścisło, Piotr, Czub, Paweł, Wilimski, Radosław, Hendzel, Piotr, Opolski, Grzegorz, Grabowski, Marcin, Mazurek, Tomasz
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623928/
https://www.ncbi.nlm.nih.gov/pubmed/34830690
http://dx.doi.org/10.3390/jcm10225408
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author Jonik, Szymon
Marchel, Michał
Pędzich-Placha, Ewa
Huczek, Zenon
Kochman, Janusz
Ścisło, Piotr
Czub, Paweł
Wilimski, Radosław
Hendzel, Piotr
Opolski, Grzegorz
Grabowski, Marcin
Mazurek, Tomasz
author_facet Jonik, Szymon
Marchel, Michał
Pędzich-Placha, Ewa
Huczek, Zenon
Kochman, Janusz
Ścisło, Piotr
Czub, Paweł
Wilimski, Radosław
Hendzel, Piotr
Opolski, Grzegorz
Grabowski, Marcin
Mazurek, Tomasz
author_sort Jonik, Szymon
collection PubMed
description Background: This retrospective study was proposed to investigate outcomes of patients with severe aortic stenosis (AS) after implementation of various treatment strategies following dedicated Heart Team (HT) decisions. Methods: Primary and secondary endpoints and quality of life during a median follow-up of 866 days of patients with severe AS qualified after HT discussion to: optimal medical treatment (OMT) alone, OMT and transcather aortic valve replacement (TAVR) or OMT and surgical aortic valve replacement (SAVR) were evaluated. As the primary endpoint composite of all-cause mortality, non-fatal disabling strokes and non-fatal rehospitalizations for AS were considered, while other clinical outcomes were determined as secondary endpoints. Results: From 2016 to 2019, 176 HT meetings were held, and a total of 482 participants with severe AS and completely implemented HT decisions (OMT, TAVR and SAVR for 79, 318 and 85, respectively) were included in the final analysis. SAVR and TAVR were found to be superior to OMT for primary and all secondary endpoints (p < 0.05). Comparing interventional strategies only, TAVR was associated with reduced risk of acute kidney injury, new onset of atrial fibrillation and major bleeding, while the superiority of SAVR for major vascular complications and need for permanent pacemaker implantation was observed (p < 0.05). The quality of life assessed at the end of follow-up was significantly better for patients who underwent TAVR or SAVR than in OMT-group (p < 0.05). Conclusions: We demonstrated that after careful implementation of HT decisions interventional strategies compared to OMT only provide superior outcomes and quality of life for patients with AS.
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spelling pubmed-86239282021-11-27 Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center Jonik, Szymon Marchel, Michał Pędzich-Placha, Ewa Huczek, Zenon Kochman, Janusz Ścisło, Piotr Czub, Paweł Wilimski, Radosław Hendzel, Piotr Opolski, Grzegorz Grabowski, Marcin Mazurek, Tomasz J Clin Med Article Background: This retrospective study was proposed to investigate outcomes of patients with severe aortic stenosis (AS) after implementation of various treatment strategies following dedicated Heart Team (HT) decisions. Methods: Primary and secondary endpoints and quality of life during a median follow-up of 866 days of patients with severe AS qualified after HT discussion to: optimal medical treatment (OMT) alone, OMT and transcather aortic valve replacement (TAVR) or OMT and surgical aortic valve replacement (SAVR) were evaluated. As the primary endpoint composite of all-cause mortality, non-fatal disabling strokes and non-fatal rehospitalizations for AS were considered, while other clinical outcomes were determined as secondary endpoints. Results: From 2016 to 2019, 176 HT meetings were held, and a total of 482 participants with severe AS and completely implemented HT decisions (OMT, TAVR and SAVR for 79, 318 and 85, respectively) were included in the final analysis. SAVR and TAVR were found to be superior to OMT for primary and all secondary endpoints (p < 0.05). Comparing interventional strategies only, TAVR was associated with reduced risk of acute kidney injury, new onset of atrial fibrillation and major bleeding, while the superiority of SAVR for major vascular complications and need for permanent pacemaker implantation was observed (p < 0.05). The quality of life assessed at the end of follow-up was significantly better for patients who underwent TAVR or SAVR than in OMT-group (p < 0.05). Conclusions: We demonstrated that after careful implementation of HT decisions interventional strategies compared to OMT only provide superior outcomes and quality of life for patients with AS. MDPI 2021-11-19 /pmc/articles/PMC8623928/ /pubmed/34830690 http://dx.doi.org/10.3390/jcm10225408 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Jonik, Szymon
Marchel, Michał
Pędzich-Placha, Ewa
Huczek, Zenon
Kochman, Janusz
Ścisło, Piotr
Czub, Paweł
Wilimski, Radosław
Hendzel, Piotr
Opolski, Grzegorz
Grabowski, Marcin
Mazurek, Tomasz
Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center
title Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center
title_full Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center
title_fullStr Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center
title_full_unstemmed Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center
title_short Heart Team for Optimal Management of Patients with Severe Aortic Stenosis—Long-Term Outcomes and Quality of Life from Tertiary Cardiovascular Care Center
title_sort heart team for optimal management of patients with severe aortic stenosis—long-term outcomes and quality of life from tertiary cardiovascular care center
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8623928/
https://www.ncbi.nlm.nih.gov/pubmed/34830690
http://dx.doi.org/10.3390/jcm10225408
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