Introduction
Aortic stenosis (AS) is the most common valvular heart disease referred for valve replacement in developed countries. Since transcatheter aortic valve replacement (TAVR) emerged as an alternative treatment to surgery (SAVR) in moderate to high-risk patients with symptomatic severe AS, the Heart Team (HT) has developed a key role in patient selection and choice of therapeutic approach (1). In fact, decision making by a multidisciplinary HT is the recommended strategy according to both the European and American Guidelines (class I recommendation) (2,3).
The function of the HT should be to decipher complex clinical situations and recommend the most appropriate treatment based on currently available evidence and patient specific factors. A particularly complex clinical scenario, yet one commonly encountered in every day clinical practice, is the apparent lack of benefit in terms of post-procedural functional improvement or survival in a subgroup of patients undergoing TAVR (4). In this setting, the HT theoretically can identify those patients in whom TAVR is likely to be futile. However, although team-based patient-specific decision making is generally accepted, very little information is available regarding the decision-making process, determinant factors of HT decisions, and outcomes of patients with AS discussed in the HT (5-7) . In order to improve patient selection and outcome and for a better understanding of the optimal care model, continuous evaluation of physician’s decisions are required. Therefore, the aims of this study were 1) to identify which factors influence the HT decision regarding the optimal therapeutic approach for a specific patient, and 2) evaluate patient’s clinical outcomes according to the assigned treatment.