Results of a heart team assessment of aortic stenosis candidates for percutaneous valve replacement in an upper-middle-income country

Abstract Objectives To analyze the results of patients with aortic stenosis (AS) who were evaluated by a heart team (HT) over a period of 10 years in a center in our city. Methods We designed a retrospective cohort study including consecutive patients with AS who were potential candidates for transcatheter aortic valve replacement (TAVI) between January 2012 and July 2021. Cases were discussed weekly by a HT consisting of at least one cardiovascular surgeon, one interventional cardiologist, one imaging specialist and one clinical cardiologist specializing in valve disease. The HT considered, among other things, the severity of AS, symptoms, surgical risk, suitability for the procedure, frailty using a 5-point scale, and access to high-cost technology. A final decision was made for all patients assessed, including TAVI, surgical aortic valve replacement (SAVR) or conservative medical treatment (CMT). The proposed treatment and the implementation of the interventions were compared. Follow-up was by personal or telephone contact. Actuarial survival analysis (Kaplan-Meier curves) included only patients who adhered to HT recommendations. Cox regression was used to identify predictors of survival. Results Of the 841 patients included in the study, 455 (53%) were assigned to TAVI (85% implanted), 213 (24%) to SAVR (86% operated) and 183 (23%) to CMT. The percentage of patients undergoing TAVI increased from 48 to 65% (p