Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data

Peyman Sardari Nia; Jules R Olsthoorn; Samuel Heuts; Sander M J van Kuijk; Jindrich Vainer; Sebastian Streukens; Simon Schalla; Patrique Segers; Paul Barenbrug; Harry J G M Crijns; Jos G Maessen

doi:10.1093/ejcts/ezab065

Effect of a dedicated mitral heart team compared to a general heart team on survival: a retrospective, comparative, non-randomized interventional cohort study based on prospectively registered data

Eur J Cardiothorac Surg. 2021 Jul 30;60(2):263-273. doi: 10.1093/ejcts/ezab065.

Authors

Peyman Sardari Nia^{1

2}, Jules R Olsthoorn¹, Samuel Heuts¹, Sander M J van Kuijk³, Jindrich Vainer⁴, Sebastian Streukens⁴, Simon Schalla^{2

4}, Patrique Segers¹, Paul Barenbrug¹, Harry J G M Crijns^{2

4}, Jos G Maessen^{1

2}

Affiliations

¹ Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.
² Cardiovascular Research Institute (CARIM), Maastricht University, Maastricht, Netherlands.
³ Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center (MUMC+), Maastricht, Netherlands.
⁴ Department of Cardiology, Maastricht University Medical Center, Maastricht, Netherlands.

PMID: 33783480
DOI: 10.1093/ejcts/ezab065

Abstract

Objectives: Although in both the US and European guidelines the 'heart team approach' is a class I recommendation, supporting evidence is still lacking. Therefore, we sought to provide comparative survival data of patients with mitral valve disease referred to the general and the dedicated heart team.

Methods: In this retrospective cohort, patients evaluated for mitral valve disease by a general heart team (2009-2014) and a dedicated mitral valve heart team (2014-2018) were included. Decision-making was recorded prospectively in heart team electronic forms. The end point was overall survival from decision of the heart team.

Results: In total, 1145 patients were included of whom 641 (56%) were discussed by dedicated heart team and 504 (44%) by general heart team. At 5 years, survival probability was 0.74 [95% confidence interval (CI) 0.68-0.79] for the dedicated heart team group compared to 0.70 (95% CI 0.66-0.74, P = 0.040) for the general heart team. Relative risk of mortality adjusted for EuroSCORE II, treatment groups (surgical, transcatheter and non-intervention), mitral valve pathology (degenerative, functional, rheumatic and others) and 13 other baseline characteristics for patients in the dedicated heart team was 29% lower [hazard ratio (HR) 0.71, 95% CI 0.54-0.95; P = 0.019] than for the general heart team. The adjusted relative risk of mortality was 61% lower for patients following the advice of the heart team (HR 0.39, 95% CI 0.25-0.62; P < 0.001) and 43% lower for patients following the advice of the general heart team (HR 0.57, 95% CI 0.37-0.87; P = 0.010) compared to those who did not follow the advice of the heart team.

Conclusions: In this retrospective cohort, patients treated for mitral valve disease based on a dedicated heart team decision have significantly higher survival independent of the allocated treatment, mitral valve pathology and baseline characteristics.

Keywords: Heart team; Mitral valve disease; Multidisciplinary decision-making.

Publication types

Clinical Trial

MeSH terms

Cohort Studies
Heart Valve Prosthesis Implantation*
Humans
Mitral Valve / surgery
Mitral Valve Insufficiency* / surgery
Retrospective Studies
Treatment Outcome