Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/22443
Title: The importance of the Heart Team evaluation before transcatheter aortic valve replacement: Results from the BRAVO-3 trial.
Austin Authors: Camaj, Anton;Claessen, Bimmer E;Mehran, Roxana;Yudi, Matias B ;Power, David;Baber, Usman;Hengstenberg, Christian;Lefevre, Thierry;Van Belle, Eric;Giustino, Gennaro;Guedeney, Paul;Sorrentino, Sabato;Kupatt, Christian;Webb, John G;Hildick-Smith, David;Hink, Hans U;Deliargyris, Efthymios N;Anthopoulos, Prodromos;Sharma, Samin K;Kini, Annapoorna;Sartori, Samantha;Chandrasekhar, Jaya;Dangas, George D
Affiliation: The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
Institut Cardio Vasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
Austin Health, Heidelberg, Victoria, Australia
Sorbonne Université, ACTION Study Group, INSERM UMRS_1166 Institut de cardiologie (AP-HP), Paris, France
Department of Cardiology and INSERM UMR 1011, University Hospital, and CHRU Lille, Lille, France
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany, and Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
LMU Munich, Munich, Germany
St. Paul's Hospital, Vancouver, British Columbia, Canada
Sussex Cardiac Centre-Brighton & Sussex University Hospitals NHS Trust, Brighton, East Sussex, UK
Universitätsmedizin Mainz, Mainz, Germany
Science and Strategy Consulting Group, Basking Ridge, New Jersey
Arena Pharmaceuticals, Inc., Zurich, Switzerland
The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
Issue Date: Dec-2020
metadata.dc.date: 2020-01-13
Publication information: Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions 2020; 96(7): E688-E694
Abstract: Clinicians use validated scores to risk-stratify patients undergoing transcatheter aortic valve replacement (TAVR). However, evaluation by the Heart Team often deems patients to be at higher risk than their formal scores suggest. We sought to assess clinical outcomes of TAVR patients defined as high-risk by the Heart Team's assessment versus the patient's logistic EuroSCORE (LES). The BRAVO-3 trial randomized patients at high risk (LES ≥ 18, or deemed inoperable by the Heart Team) to TAVR with periprocedural anticoagulation with unfractionated heparin versus bivalirudin. Endpoints included net adverse cardiac events (NACE: the composite of all-cause mortality, MI, stroke, or bleeding), major adverse cardiovascular events (MACE: death, MI, or stroke), the individual components of MACE, major vascular complications, BARC ≥ 3b bleeding and VARC life-threatening bleeding at 30 days. We compared patients deemed high-risk based on LES ≥ 18 versus high-risk by the Heart Team despite lower LES. A total of 467/800 (58.4%) patients were deemed high-risk by the Heart Team despite LES < 18. After multivariable analysis, there were no differences in the odds of endpoints between groups (NACE, ORLES≥18 : 1.32, 95% CI 0.86-2.02, p = .21; MACE, ORLES≥18 : 1.27, 95% CI 0.72-2.25, p = .41; major vascular complications, ORLES≥18 : 0.97, 95% CI 0.65-1.44, p = .88; BARC ≥3b, ORLES≥18 : 1.38, 95% CI 0.82-2.33, p = .23; and VARC life-threatening bleeding, ORLES≥18 : 0.99, 95% CI 0.69-1.41, p = .95). Patients undergoing TAVR and labeled high-risk by LES ≥ 18 or Heart Team assessment despite LES < 18 have comparable short-term outcomes. Assignment of high-risk status to over 50% of patients is attributable to Heart Team's clinical assessment.
URI: http://ahro.austin.org.au/austinjspui/handle/1/22443
DOI: 10.1002/ccd.28717
ORCID: 0000-0002-2012-4137
0000-0002-3706-4150
0000-0002-1888-0793
0000-0002-7189-3307
0000-0001-7502-8049
0000-0002-3706-4150
PubMed URL: 31943717
Type: Journal Article
Subjects: Heart Team
TAVR
logistic EuroSCORE
Appears in Collections:Journal articles

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