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.