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Abstract：
BACKGROUND: Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are Class Ia recommended therapies for specific subgroups of severe aortic stenosis (AS) patients in the latest 2021 European guidelines.
OBJECTIVE: We aimed to report on the multidisciplinary Heart Team evaluation process and real-world practice of treating severe symptomatic AS in East Denmark in the context of the latest European guideline recommendations.
METHODS: All consecutive patients with severe AS referred for intervention in 2021 (N=672) were discussed in a multidisciplinary Heart Team meeting. All patients (100%) had a cardiac computed tomography (CT) analysis prior to the meeting. Baseline characteristics, Heart Team decision-making, final treatment and 30-day clinical outcomes were prospectively recorded.
RESULTS: The majority of severe AS patients (N=456, 68%) were referred for TAVI following discussion in the Heart Team. Ultimately, 94% of patients (N=632) received the Heart Team-recommended treatment. Patients undergoing TAVI (N=439) were significantly older (78.4±6.7 vs 67.2±8.3 years; p<0.001) and more comorbid than patients undergoing SAVR (N=189). The overall 30-day clinical outcomes were satisfactory for both treatment groups (overall 30-day mortality: 1.1%). The mean index hospitalisation length was markedly longer in the SAVR group (8.6±8.3 days) as compared to the TAVI group (1.8±3.2 days).
CONCLUSIONS: TAVI was routinely performed in low surgical risk patients in 2021 with two-thirds of all severe AS patients undergoing TAVI, thereby applying the latest European guidelines. A dedicated Heart Team meeting, including CT evaluation for all AS patients, is needed to make individualised management decisions in this new era of aortic valve interventions.
OBJECTIVE: We aimed to report on the multidisciplinary Heart Team evaluation process and real-world practice of treating severe symptomatic AS in East Denmark in the context of the latest European guideline recommendations.
METHODS: All consecutive patients with severe AS referred for intervention in 2021 (N=672) were discussed in a multidisciplinary Heart Team meeting. All patients (100%) had a cardiac computed tomography (CT) analysis prior to the meeting. Baseline characteristics, Heart Team decision-making, final treatment and 30-day clinical outcomes were prospectively recorded.
RESULTS: The majority of severe AS patients (N=456, 68%) were referred for TAVI following discussion in the Heart Team. Ultimately, 94% of patients (N=632) received the Heart Team-recommended treatment. Patients undergoing TAVI (N=439) were significantly older (78.4±6.7 vs 67.2±8.3 years; p<0.001) and more comorbid than patients undergoing SAVR (N=189). The overall 30-day clinical outcomes were satisfactory for both treatment groups (overall 30-day mortality: 1.1%). The mean index hospitalisation length was markedly longer in the SAVR group (8.6±8.3 days) as compared to the TAVI group (1.8±3.2 days).
CONCLUSIONS: TAVI was routinely performed in low surgical risk patients in 2021 with two-thirds of all severe AS patients undergoing TAVI, thereby applying the latest European guidelines. A dedicated Heart Team meeting, including CT evaluation for all AS patients, is needed to make individualised management decisions in this new era of aortic valve interventions.
摘要：
背景：在最新的2021年欧洲指南中，外科主动脉瓣置换术（SAVR）和经导管主动脉瓣植入术（TAVI）都是针对严重主动脉瓣狭窄（AS）患者特定亚组的Ia类推荐疗法。
目的：我们的目的是在最新的欧洲指南建议的背景下，报告东丹麦多学科心脏团队评估过程和治疗严重症状性AS的实际实践。
方法：在多学科心脏团队会议上讨论了所有在2021年（N=672）接受干预的重度AS患者。在会议之前，所有患者（100％）都进行了心脏计算机断层扫描（CT）分析。基线特征，心脏团队决策，前瞻性记录最终治疗和30日临床结局.
结果：在心脏小组的讨论之后，大多数重度AS患者（N=456，68％）被转诊为TAVI。最终,94%的患者（N=632）接受了心脏团队推荐的治疗。接受TAVI（N=439）的患者年龄明显（78.4±6.7vs67.2±8.3岁；p<0.001），并且与接受SAVR（N=189）的患者相比，合并症更多。两个治疗组的30天总体临床结果均令人满意（30天总体死亡率：1.1%）。与TAVI组（1.8±3.2天）相比，SAVR组（8.6±8.3天）的平均住院时间明显更长。
结论：2021年在低手术风险患者中常规进行TAVI，其中三分之二的严重AS患者接受TAVI，从而应用最新的欧洲准则。一个专门的心脏团队会议，包括所有AS患者的CT评估，在主动脉瓣干预的新时代，需要做出个性化的管理决策。
目的：我们的目的是在最新的欧洲指南建议的背景下，报告东丹麦多学科心脏团队评估过程和治疗严重症状性AS的实际实践。
方法：在多学科心脏团队会议上讨论了所有在2021年（N=672）接受干预的重度AS患者。在会议之前，所有患者（100％）都进行了心脏计算机断层扫描（CT）分析。基线特征，心脏团队决策，前瞻性记录最终治疗和30日临床结局.
结果：在心脏小组的讨论之后，大多数重度AS患者（N=456，68％）被转诊为TAVI。最终,94%的患者（N=632）接受了心脏团队推荐的治疗。接受TAVI（N=439）的患者年龄明显（78.4±6.7vs67.2±8.3岁；p<0.001），并且与接受SAVR（N=189）的患者相比，合并症更多。两个治疗组的30天总体临床结果均令人满意（30天总体死亡率：1.1%）。与TAVI组（1.8±3.2天）相比，SAVR组（8.6±8.3天）的平均住院时间明显更长。
结论：2021年在低手术风险患者中常规进行TAVI，其中三分之二的严重AS患者接受TAVI，从而应用最新的欧洲准则。一个专门的心脏团队会议，包括所有AS患者的CT评估，在主动脉瓣干预的新时代，需要做出个性化的管理决策。
