Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data

Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data

Abstract   OBJECTIVES Although in both the US and European guidelines the ‘heart team approach’ is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated...

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Veröffentlicht in:European journal of cardio-thoracic surgery 2021-08, Vol.60 (2), p.263-273
Hauptverfasser: Sardari Nia, Peyman, Olsthoorn, Jules R, Heuts, Samuel, van Kuijk, Sander M J, Vainer, Jindrich, Streukens, Sebastian, Schalla, Simon, Segers, Patrique, Barenbrug, Paul, Crijns, Harry J G M, Maessen, Jos G
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container_issue 2
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container_title European journal of cardio-thoracic surgery
container_volume 60
creator Sardari Nia, Peyman
Olsthoorn, Jules R
Heuts, Samuel
van Kuijk, Sander M J
Vainer, Jindrich
Streukens, Sebastian
Schalla, Simon
Segers, Patrique
Barenbrug, Paul
Crijns, Harry J G M
Maessen, Jos G
description Abstract   OBJECTIVES Although in both the US and European guidelines the ‘heart team approach’ is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team. METHODS In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009–2014) and a dedicated mitral valve heart team (2014–2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team. RESULTS In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68–0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66–0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54–0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25–0.62; P 
doi_str_mv 10.1093/ejcts/ezab065
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Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team. METHODS In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009–2014) and a dedicated mitral valve heart team (2014–2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team. RESULTS In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68–0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66–0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54–0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25–0.62; P &lt; 0.001) and 43% lower for patients following the advice of the general heart team (HR 0.57, 95% CI 0.37–0.87; P = 0.010) compared to those who did not follow the advice of the heart team. CONCLUSIONS In this retrospective cohort, patients treated for mitral valve disease based on a dedicated heart team decision have significantly higher survival independent of the allocated treatment, mitral valve pathology and baseline characteristics.</description><identifier>ISSN: 1010-7940</identifier><identifier>EISSN: 1873-734X</identifier><identifier>DOI: 10.1093/ejcts/ezab065</identifier><identifier>PMID: 33783480</identifier><language>eng</language><publisher>Germany: Oxford University Press</publisher><ispartof>European journal of cardio-thoracic surgery, 2021-08, Vol.60 (2), p.263-273</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c365t-3b199da3bed8874a7f902d155a7218c7e995b106b3a06849f459c993859b063</citedby><cites>FETCH-LOGICAL-c365t-3b199da3bed8874a7f902d155a7218c7e995b106b3a06849f459c993859b063</cites><orcidid>0000-0002-7414-3712 ; 0000-0003-3531-9997 ; 0000-0003-2296-1497</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,1579,27905,27906</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33783480$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sardari Nia, Peyman</creatorcontrib><creatorcontrib>Olsthoorn, Jules R</creatorcontrib><creatorcontrib>Heuts, Samuel</creatorcontrib><creatorcontrib>van Kuijk, Sander M J</creatorcontrib><creatorcontrib>Vainer, Jindrich</creatorcontrib><creatorcontrib>Streukens, Sebastian</creatorcontrib><creatorcontrib>Schalla, Simon</creatorcontrib><creatorcontrib>Segers, Patrique</creatorcontrib><creatorcontrib>Barenbrug, Paul</creatorcontrib><creatorcontrib>Crijns, Harry J G M</creatorcontrib><creatorcontrib>Maessen, Jos G</creatorcontrib><title>Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data</title><title>European journal of cardio-thoracic surgery</title><addtitle>Eur J Cardiothorac Surg</addtitle><description>Abstract   OBJECTIVES Although in both the US and European guidelines the ‘heart team approach’ is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team. METHODS In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009–2014) and a dedicated mitral valve heart team (2014–2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team. RESULTS In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68–0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66–0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54–0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25–0.62; P &lt; 0.001) and 43% lower for patients following the advice of the general heart team (HR 0.57, 95% CI 0.37–0.87; P = 0.010) compared to those who did not follow the advice of the heart team. CONCLUSIONS In this retrospective cohort, patients treated for mitral valve disease based on a dedicated heart team decision have significantly higher survival independent of the allocated treatment, mitral valve pathology and baseline characteristics.</description><issn>1010-7940</issn><issn>1873-734X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkU1v1DAQhiNERUvhyBX5yIFQex3HMTdUlQ-pUg9w4BZN7EnrKrGD7ay0_X_9X0zZhUpcerKteeaZkd-qeiP4B8GNPMNbW_IZ3sHAW_WsOhGdlrWWzc_ndOeC19o0_Lh6mfMt57yVG_2iOpZSd7Lp-El1fzGOaAuLIwPm0HkLBR2bfUkwsRuEVFhBmJmN8wKJSiUSeY0B_wNiYHlNW7-F6SMRCUuKeSG33-L7QzvsHyGGOkFwcfZ3ZPShYNpiKD4Gctp4E0may-p2bIBMBLmXR9u0I_u1z9RFNQcFXlVHI0wZXx_O0-r754sf51_ry6sv384_XdZWtqrUchDGOJADuq7TDejR8I0TSoHeiM5qNEYNgreDBN52jRkbZawxslOGfleeVu_2Vtrl14q59LPPFqcJAsY19xvFtVBctJzQeo9aWjsnHPsl-RnSrhe8f8it_5Nbf8iN-LcH9TrM6P7Rf4N6nB3X5QnXb5RxqGE</recordid><startdate>20210801</startdate><enddate>20210801</enddate><creator>Sardari Nia, Peyman</creator><creator>Olsthoorn, Jules R</creator><creator>Heuts, Samuel</creator><creator>van Kuijk, Sander M J</creator><creator>Vainer, Jindrich</creator><creator>Streukens, Sebastian</creator><creator>Schalla, Simon</creator><creator>Segers, Patrique</creator><creator>Barenbrug, Paul</creator><creator>Crijns, Harry J G M</creator><creator>Maessen, Jos G</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7414-3712</orcidid><orcidid>https://orcid.org/0000-0003-3531-9997</orcidid><orcidid>https://orcid.org/0000-0003-2296-1497</orcidid></search><sort><creationdate>20210801</creationdate><title>Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data</title><author>Sardari Nia, Peyman ; Olsthoorn, Jules R ; Heuts, Samuel ; van Kuijk, Sander M J ; Vainer, Jindrich ; Streukens, Sebastian ; Schalla, Simon ; Segers, Patrique ; Barenbrug, Paul ; Crijns, Harry J G M ; Maessen, Jos G</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c365t-3b199da3bed8874a7f902d155a7218c7e995b106b3a06849f459c993859b063</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sardari Nia, Peyman</creatorcontrib><creatorcontrib>Olsthoorn, Jules R</creatorcontrib><creatorcontrib>Heuts, Samuel</creatorcontrib><creatorcontrib>van Kuijk, Sander M J</creatorcontrib><creatorcontrib>Vainer, Jindrich</creatorcontrib><creatorcontrib>Streukens, Sebastian</creatorcontrib><creatorcontrib>Schalla, Simon</creatorcontrib><creatorcontrib>Segers, Patrique</creatorcontrib><creatorcontrib>Barenbrug, Paul</creatorcontrib><creatorcontrib>Crijns, Harry J G M</creatorcontrib><creatorcontrib>Maessen, Jos G</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of cardio-thoracic surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sardari Nia, Peyman</au><au>Olsthoorn, Jules R</au><au>Heuts, Samuel</au><au>van Kuijk, Sander M J</au><au>Vainer, Jindrich</au><au>Streukens, Sebastian</au><au>Schalla, Simon</au><au>Segers, Patrique</au><au>Barenbrug, Paul</au><au>Crijns, Harry J G M</au><au>Maessen, Jos G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data</atitle><jtitle>European journal of cardio-thoracic surgery</jtitle><addtitle>Eur J Cardiothorac Surg</addtitle><date>2021-08-01</date><risdate>2021</risdate><volume>60</volume><issue>2</issue><spage>263</spage><epage>273</epage><pages>263-273</pages><issn>1010-7940</issn><eissn>1873-734X</eissn><abstract>Abstract   OBJECTIVES Although in both the US and European guidelines the ‘heart team approach’ is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team. METHODS In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009–2014) and a dedicated mitral valve heart team (2014–2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team. RESULTS In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68–0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66–0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54–0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25–0.62; P &lt; 0.001) and 43% lower for patients following the advice of the general heart team (HR 0.57, 95% CI 0.37–0.87; P = 0.010) compared to those who did not follow the advice of the heart team. CONCLUSIONS In this retrospective cohort, patients treated for mitral valve disease based on a dedicated heart team decision have significantly higher survival independent of the allocated treatment, mitral valve pathology and baseline characteristics.</abstract><cop>Germany</cop><pub>Oxford University Press</pub><pmid>33783480</pmid><doi>10.1093/ejcts/ezab065</doi><tpages>11</tpages><orcidid>https://orcid.org/0000-0002-7414-3712</orcidid><orcidid>https://orcid.org/0000-0003-3531-9997</orcidid><orcidid>https://orcid.org/0000-0003-2296-1497</orcidid><oa>free_for_read</oa></addata></record>
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title Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data
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