Rodighiero Julia, Alakhtar Ali M, Baker Nouf, Zgheib Ali, de Varennes Benoit, Lachapelle Kevin, Cecere Renzo, Ergina Patrick, Tchervenkov Christo, Shum-Tim Dominique, Martucci Giuseppe, Piazza Nicolo, Afilalo Jonathan, Spaziano Marco
Division of Cardiology, McGill University Health Centre, Montreal, Quebec, Canada.
Division of Cardiac Surgery, McGill University Health Centre, Montreal, Quebec, Canada.
CJC Open. 2022 Oct 13;5(1):24-34. doi: 10.1016/j.cjco.2022.10.003. eCollection 2023 Jan.
This study sought to compare characteristics and outcomes of patients who underwent surgical aortic valve replacement (SAVR) after being referred to a heart team (HT), to those of patients referred directly for SAVR.
An analysis of patients who underwent SAVR from 2015 to 2020 was conducted. Patients were categorized into 3 groups, as follows: (i) H-HT: patients referred to the HT from 2015 to 2017 (historical cohort); (ii) C-HT: patients referred to the HT from 2018 to 2020 (contemporary cohort); and (iii) No-HT: patients referred directly to cardiac surgery from 2018 to 2020. Two subanalyses were performed: H-HT vs C-HT patients, and C-HT vs No-HT patients. The primary outcome was a composite of in-hospital mortality, prolonged intubation, reoperation, sternal wound infection, and stroke.
This study consisted of 288 patients, distributed as follows: H-HT (n = 45); C-HT (n = 51); and No-HT (n = 192). The mean ages of H-HT, C-HT, and No-HT patients was 76.3 ± 6.9 years, 73.3 ± 7.6 years, and 69.6 ± 9.7 years, respectively ( = 0.0001). H-HT, C-HT, and No-HT patients had average Society of Thoracic Surgeons scores of 4.8 ± 2.2, 3.2 ± 1.6, and 4.2 ± 2 ( = 0.002), respectively. The composite outcome rate was more than 5 times higher among H-HT patients compared to that among the C-HT patients (20.0 vs 3.9%, = 0.02), and was numerically higher in No-HT compared to C-HT patients (13.0 vs 3.9%, = 0.07).
Referral to an HT appears to be primarily driven by higher chronological age rather than overall risk profile. Patients assessed by the HT prior to undergoing SAVR have a low incidence of complications, comparable to that among patients referred directly to cardiac surgery.
本研究旨在比较被转诊至心脏团队（HT）后接受外科主动脉瓣置换术（SAVR）的患者与直接被转诊接受SAVR的患者的特征和结局。
对2015年至2020年接受SAVR的患者进行分析。患者分为3组，如下：（i）H-HT组：2015年至2017年被转诊至心脏团队的患者（历史队列）；（ii）C-HT组：2018年至2020年被转诊至心脏团队的患者（当代队列）；（iii）非HT组：2018年至2020年直接被转诊至心脏外科的患者。进行了两项亚分析：H-HT组与C-HT组患者，以及C-HT组与非HT组患者。主要结局是住院死亡率、延长插管时间、再次手术、胸骨伤口感染和中风的复合结局。
本研究包括288例患者，分布如下：H-HT组（n = 45）；C-HT组（n = 51）；非HT组（n = 192）。H-HT组、C-HT组和非HT组患者的平均年龄分别为76.3±6.9岁、73.3±7.6岁和69.6±9.7岁（P = 0.0001）。H-HT组、C-HT组和非HT组患者的胸外科医师协会平均评分分别为4.8±2.2、3.2±1.6和4.2±2（P = 0.002）。H-HT组患者的复合结局发生率比C-HT组患者高出5倍多（20.0%对3.9%，P = 0.02），非HT组患者的复合结局发生率在数值上高于C-HT组患者（13.0%对3.9%，P = 0.07）。
转诊至心脏团队似乎主要是由较高的实际年龄而非总体风险状况驱动的。在接受SAVR之前由心脏团队评估的患者并发症发生率较低，与直接被转诊至心脏外科的患者相当。
