Editorial comment
The heart team approach to transcatheter aortic valve implantation: What has been done and what is to be expected
Abordagem da Heart Team à TAVI: o que tem sido feito e o que se espera
Gustavo Pires-Morais
, Vasco Gama
Autor para correspondência
Cardiovascular Intervention Unit, Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
Lido
5819
Vezesque se leu este artigo
1850
Total PDF
3969
Total HTML
Compartilhar estatísticas
array:25 [ "pii" => "S0870255117307965" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.10.009" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1107" "copyrightAnyo" => "2017" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2017;36:819-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1566 "formatos" => array:3 [ "EPUB" => 158 "HTML" => 1060 "PDF" => 348 ] ] "Traduccion" => array:1 [ "en" => array:19 [ "pii" => "S2174204917303227" "issn" => "21742049" "doi" => "10.1016/j.repce.2017.11.001" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1107" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "dis" "cita" => "Rev Port Cardiol. 2017;36:819-21" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1183 "formatos" => array:3 [ "EPUB" => 126 "HTML" => 842 "PDF" => 215 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "The heart team approach to transcatheter aortic valve implantation: What has been done and what is to be expected" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "819" "paginaFinal" => "821" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Abordagem da <span class="elsevierStyleItalic">Heart Team</span> à TAVI: o que tem sido feito e o que se espera" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gustavo Pires-Morais, Vasco Gama" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Pires-Morais" ] 1 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117307965" "doi" => "10.1016/j.repc.2017.10.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117307965?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303227?idApp=UINPBA00004E" "url" => "/21742049/0000003600000011/v1_201712190639/S2174204917303227/v1_201712190639/en/main.assets" ] ] "itemSiguiente" => array:20 [ "pii" => "S0870255116302852" "issn" => "08702551" "doi" => "10.1016/j.repc.2017.01.009" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1095" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:823-30" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1892 "formatos" => array:3 [ "EPUB" => 141 "HTML" => 1336 "PDF" => 415 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Venous thromboembolism risk and prophylaxis in the Portuguese hospital care setting: The ARTE study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "823" "paginaFinal" => "830" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Risco de tromboembolismo venoso e tromboprofilaxia nos hospitais portugueses – Estudo ARTE" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1903 "Ancho" => 2118 "Tamanyo" => 189513 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Study flow diagram. <span class="elsevierStyleSup">a</span>Of the total 4248 patients originally included, 158 were excluded, of whom 63 (39.9%) did not fulfill eligibility criteria, 44 (27.9%) had seriously incomplete records, 42 (26.6%) had no available weight data, and nine (5.7%) had no available hospital discharge and/or follow-up data.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Daniel Ferreira, Joaquim Abreu de Sousa, Paulo Felicíssimo, Ana França" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Daniel" "apellidos" => "Ferreira" ] 1 => array:2 [ "nombre" => "Joaquim Abreu" "apellidos" => "de Sousa" ] 2 => array:2 [ "nombre" => "Paulo" "apellidos" => "Felicíssimo" ] 3 => array:2 [ "nombre" => "Ana" "apellidos" => "França" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917303276" "doi" => "10.1016/j.repce.2017.11.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303276?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302852?idApp=UINPBA00004E" "url" => "/08702551/0000003600000011/v2_201801180628/S0870255116302852/v2_201801180628/en/main.assets" ] "itemAnterior" => array:20 [ "pii" => "S0870255116302803" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.11.015" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1094" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:809-18" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1684 "formatos" => array:3 [ "EPUB" => 155 "HTML" => 1138 "PDF" => 391 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "809" "paginaFinal" => "818" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Vantagens de uma abordagem multidisciplinar na avaliação de doentes em programa VAP: oito anos de experiência" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1747 "Ancho" => 2508 "Tamanyo" => 243983 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curves of the different therapeutic strategies. SAVR: surgical aortic valve replacement; TAVI: transcatheter aortic valve implantation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cátia Costa, Rui Campante Teles, João Brito, José Pedro Neves, Henrique Mesquita Gabriel, Miguel Abecassis, Regina Ribeiras, João Abecasis, Tiago Nolasco, Maria da Conceição Furstenau, Nélson Vale, António Tralhão, Sérgio Madeira, João Mesquita, Carla Saraiva, Rita Calé, Manuel Almeida, Ana Aleixo, Miguel Mendes" "autores" => array:19 [ 0 => array:2 [ "nombre" => "Cátia" "apellidos" => "Costa" ] 1 => array:2 [ "nombre" => "Rui Campante" "apellidos" => "Teles" ] 2 => array:2 [ "nombre" => "João" "apellidos" => "Brito" ] 3 => array:2 [ "nombre" => "José Pedro" "apellidos" => "Neves" ] 4 => array:2 [ "nombre" => "Henrique Mesquita" "apellidos" => "Gabriel" ] 5 => array:2 [ "nombre" => "Miguel" "apellidos" => "Abecassis" ] 6 => array:2 [ "nombre" => "Regina" "apellidos" => "Ribeiras" ] 7 => array:2 [ "nombre" => "João" "apellidos" => "Abecasis" ] 8 => array:2 [ "nombre" => "Tiago" "apellidos" => "Nolasco" ] 9 => array:2 [ "nombre" => "Maria da Conceição" "apellidos" => "Furstenau" ] 10 => array:2 [ "nombre" => "Nélson" "apellidos" => "Vale" ] 11 => array:2 [ "nombre" => "António" "apellidos" => "Tralhão" ] 12 => array:2 [ "nombre" => "Sérgio" "apellidos" => "Madeira" ] 13 => array:2 [ "nombre" => "João" "apellidos" => "Mesquita" ] 14 => array:2 [ "nombre" => "Carla" "apellidos" => "Saraiva" ] 15 => array:2 [ "nombre" => "Rita" "apellidos" => "Calé" ] 16 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almeida" ] 17 => array:2 [ "nombre" => "Ana" "apellidos" => "Aleixo" ] 18 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917303288" "doi" => "10.1016/j.repce.2017.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303288?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302803?idApp=UINPBA00004E" "url" => "/08702551/0000003600000011/v2_201801180628/S0870255116302803/v2_201801180628/en/main.assets" ] "asociados" => array:1 [ 0 => array:20 [ "pii" => "S0870255116302803" "issn" => "08702551" "doi" => "10.1016/j.repc.2016.11.015" "estado" => "S300" "fechaPublicacion" => "2017-11-01" "aid" => "1094" "copyright" => "Sociedade Portuguesa de Cardiologia" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Rev Port Cardiol. 2017;36:809-18" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 1684 "formatos" => array:3 [ "EPUB" => 155 "HTML" => 1138 "PDF" => 391 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: Eight years of experience" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "809" "paginaFinal" => "818" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Vantagens de uma abordagem multidisciplinar na avaliação de doentes em programa VAP: oito anos de experiência" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1747 "Ancho" => 2508 "Tamanyo" => 243983 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curves of the different therapeutic strategies. SAVR: surgical aortic valve replacement; TAVI: transcatheter aortic valve implantation.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Cátia Costa, Rui Campante Teles, João Brito, José Pedro Neves, Henrique Mesquita Gabriel, Miguel Abecassis, Regina Ribeiras, João Abecasis, Tiago Nolasco, Maria da Conceição Furstenau, Nélson Vale, António Tralhão, Sérgio Madeira, João Mesquita, Carla Saraiva, Rita Calé, Manuel Almeida, Ana Aleixo, Miguel Mendes" "autores" => array:19 [ 0 => array:2 [ "nombre" => "Cátia" "apellidos" => "Costa" ] 1 => array:2 [ "nombre" => "Rui Campante" "apellidos" => "Teles" ] 2 => array:2 [ "nombre" => "João" "apellidos" => "Brito" ] 3 => array:2 [ "nombre" => "José Pedro" "apellidos" => "Neves" ] 4 => array:2 [ "nombre" => "Henrique Mesquita" "apellidos" => "Gabriel" ] 5 => array:2 [ "nombre" => "Miguel" "apellidos" => "Abecassis" ] 6 => array:2 [ "nombre" => "Regina" "apellidos" => "Ribeiras" ] 7 => array:2 [ "nombre" => "João" "apellidos" => "Abecasis" ] 8 => array:2 [ "nombre" => "Tiago" "apellidos" => "Nolasco" ] 9 => array:2 [ "nombre" => "Maria da Conceição" "apellidos" => "Furstenau" ] 10 => array:2 [ "nombre" => "Nélson" "apellidos" => "Vale" ] 11 => array:2 [ "nombre" => "António" "apellidos" => "Tralhão" ] 12 => array:2 [ "nombre" => "Sérgio" "apellidos" => "Madeira" ] 13 => array:2 [ "nombre" => "João" "apellidos" => "Mesquita" ] 14 => array:2 [ "nombre" => "Carla" "apellidos" => "Saraiva" ] 15 => array:2 [ "nombre" => "Rita" "apellidos" => "Calé" ] 16 => array:2 [ "nombre" => "Manuel" "apellidos" => "Almeida" ] 17 => array:2 [ "nombre" => "Ana" "apellidos" => "Aleixo" ] 18 => array:2 [ "nombre" => "Miguel" "apellidos" => "Mendes" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2174204917303288" "doi" => "10.1016/j.repce.2017.11.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204917303288?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255116302803?idApp=UINPBA00004E" "url" => "/08702551/0000003600000011/v2_201801180628/S0870255116302803/v2_201801180628/en/main.assets" ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "The heart team approach to transcatheter aortic valve implantation: What has been done and what is to be expected" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "819" "paginaFinal" => "821" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Gustavo Pires-Morais, Vasco Gama" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Gustavo" "apellidos" => "Pires-Morais" "email" => array:1 [ 0 => "gpmorais@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Vasco" "apellidos" => "Gama" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Cardiovascular Intervention Unit, Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Abordagem da <span class="elsevierStyleItalic">Heart Team</span> à TAVI: o que tem sido feito e o que se espera" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Aortic stenosis is the most common acquired valvular heart disease in Europe. Its importance is growing not only because of its prevalence, but also because percutaneous treatment options have emerged in the last fifteen years that provide validated and effective treatment for previously untreatable patients.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">1,2</span></a> Although a variety of devices are now available for treating patients of advanced age and with complex disease, not all patients are suitable candidates for transcatheter aortic valve implantation (TAVI), and patient selection remains a challenge.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The world's first TAVI procedure was performed by Alan Cribier in 2002.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">3</span></a> The technique was first used in Portugal five years later in August 2007,<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">4</span></a> and since then many other centers have developed a TAVI program.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">5</span></a> There are now as many as eleven functioning TAVI centers in Portugal, which annually perform over 56 procedures per million population, a figure that is growing.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Comorbidity, disability, and frailty are three entities that are particularly associated with elderly candidates.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">6</span></a> The STS/ACC TVT Registry reports that TAVI patients are elderly, highly symptomatic and frail, with multiple comorbidities and advanced functional class, a high Society of Thoracic Surgeons-predicted risk of mortality, and poor self-reported health status.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">7</span></a> Considering all these factors, it is not surprising that a significant percentage of patients die or fail to show improved quality of life in follow-up. The need to optimize the decision-making process in these complex patients has led to increased interaction between different specialties. Thus the concept of the heart team was born and has been widely applied ever since.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The value of a dedicated heart team assessment prior to TAVI is best shown by the team's ability to bring multidisciplinary clinical expertise to bear on two aspects of patient eligibility: risk stratification and analysis of futility. Integrating these two aspects should allow for better performance in assessing how the patient's quality of life and survival may be influenced by the valve disease and associated conditions, and in determining the treatment option that best balances risk and benefit. The importance of a heart team assessment is acknowledged in current practice guidelines, but is not reflected in a substantial quantity of publications on real-life applications.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Costa et al.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">8</span></a> address the advantages of a systematic multidisciplinary approach to TAVI patients and provide insight into the heart team's assessment of TAVI candidates in a single large-volume national center.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The authors describe three steps for patient assessment: clinical assessment, non-invasive and invasive tests, and finally a multidisciplinary discussion. For the latter, a multidisciplinary team composed of clinical and interventional cardiologists, experts in cardiac imaging, heart failure specialists and cardiac surgeons meet regularly to define treatment strategies. Notably, the article is co-authored by a multidisciplinary team from different medical centers composed of the above-mentioned areas of expertise, as well as a researcher at the Chronic Diseases Research Center (CEDOC) of Nova Medical School.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The sample included 473 patients from 2008 to 2015, in 383 of whom a heart team assessment was completed. A significant number of patients were selected for surgical aortic valve replacement (SAVR) (20.9%) or for medical therapy alone (23.2%) (overall 169 of 383, 44.1%), reflecting the wide range of patient complexity. Those undergoing SAVR or TAVI were followed at 30 days, six months and one year after the procedure, and then annually; the authors do not mention a systematic follow-up of patients under medical therapy alone, which was presumably performed by the clinical cardiologist. The criteria for TAVI included inoperability or high surgical risk, and a subjective assessment of lack of futility.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A simple dedicated TAVI risk score remains an unmet clinical need. Most risk scores were designed for surgical risk, and patients under analysis for TAVI are beyond that stage. Integration with variables such as frailty (including muscle strength, gait speed, weight loss, exhaustion, and level of activity), the patient's capacity for self-care, and home oxygen use appear to contribute to more precise stratification. The TAVI<span class="elsevierStyleInf">2</span>-SCORe by Debonnaire et al. stratifies patients into five risk groups for one-year mortality based on a retrospective analysis of 511 individuals who underwent TAVI, with better results than the logistic EuroSCORE.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">9</span></a> Hermiller et al. published a novel score for early and late mortality in extreme-risk and high-risk patients that accurately stratified patients into low, moderate and high risk,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">10</span></a> while Capodanno et al. proposed a simple seven-factor risk tool (the OBSERVANT score) for prediction of 30-day mortality after TAVI.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">In parallel with risk stratification is the development of new tools for predicting clinical futility, and this entails looking at the patient from a different angle. Futility can be defined by the combination of death and/or absence of improvement in functional class during short-term follow-up post-procedure (six months to one year). Other definitions are possible and this is still a hotly debated topic. Factors influencing futility of treatment include non-cardiovascular conditions such as chronic lung disease (CLD), advanced chronic kidney disease and frailty, and various cardiovascular conditions, including reduced left ventricular ejection fraction, pulmonary hypertension, low trans-aortic gradient, low-flow state or severe organic mitral regurgitation.<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">12</span></a> An analysis of futility has been performed for a Portuguese TAVI population of 340 patients with a mean STS score of 5.67±4.17%. The authors found that age, CLD, New York Heart Association functional class ≥III prior to the procedure and a non-transfemoral approach were predictors of futility for this population.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">13</span></a> Apart from its clinical impact, analysis of futility is also closely related to the healthcare costs of TAVI.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Although the TAVI and SAVR groups appear to have performed well in the population analyzed by Costa et al., there is still room for improvement, as the authors recognize. The fact that many patients died (12% of the study population) while awaiting heart team assessment or TAVI itself is a reminder of the severity of these patients and that appropriate strategies need to provide a more timely response from the healthcare system.</p><p id="par0055" class="elsevierStylePara elsevierViewall">Heart team assessment should not only help clarify which patients are unlikely to benefit from TAVI, but should also translate into a positive effect on healthcare costs. Perhaps one of the most important statements by Costa et al. is that results are continuously monitored and all clinical and procedural data are collected in a dedicated database (Cardiobase) and included in an ongoing registry, the Valve Catheter Restorative Operation on Santa Cruz Hospital (VCROSS). It is reassuring to know that monitoring of results is taking place. This is critical for self-evaluation and improvement in any system and should be highlighted as a reference for currently implemented systems at other intervention centers.</p><p id="par0060" class="elsevierStylePara elsevierViewall">To conclude, the accurate measurement of procedural outcomes for TAVI patients should include procedure-related clinical events, and also an assessment of quality of life and functional capacity. In the population analyzed by Costa et al., an analysis of quality of life and characterization of patients for whom the procedure was deemed futile could expand the analysis of the quality of treatment. Performing this analysis for the population of the national TAVI registry and determining predictors of futility could result in a valuable tool for heart teams in the future.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0065" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:13 [ 0 => array:3 [ "identificador" => "bib0070" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 ESC/EACTS Guidelines for the management of valvular heart disease: the Task Force for the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Baumgartner" 1 => "V. Falk" 2 => "J.J. Bax" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehx391" "Revista" => array:6 [ "tituloSerie" => "Eur Heart J" "fecha" => "2017" "volumen" => "38" "paginaInicial" => "2739" "paginaFinal" => "2786" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28886619" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0075" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.A. Nishimura" 1 => "C.M. Otto" 2 => "R.O. Bonow" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2017.03.011" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2017" "volumen" => "70" "paginaInicial" => "252" "paginaFinal" => "289" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28315732" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0080" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Cribier" 1 => "H. Eltchaninoff" 2 => "A. Bash" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Circulation" "fecha" => "2002" "volumen" => "106" "paginaInicial" => "3006" "paginaFinal" => "3008" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12473543" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673614619425" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0085" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implantação da válvula aórtica por via percutânea" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Caeiro" 1 => "R. Fontes-Carvalho" 2 => "R. Lima" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2010" "volumen" => "29" "paginaInicial" => "1699" "paginaFinal" => "1712" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21309359" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0090" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Portugal: coronary and structural heart interventions from 2010 to 2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R.C. Teles" 1 => "G. Pires-Morais" 2 => "P. Canas da Silva" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4244/EIJ-D-16-00831" "Revista" => array:6 [ "tituloSerie" => "Eurointervention" "fecha" => "2017" "volumen" => "13" "paginaInicial" => "Z55" "paginaFinal" => "Z58" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28504232" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0095" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "ANMCO/SIC/SICI-GISE/SICCH Executive Summary of Consensus Document on Risk Stratification in elderly patients with aortic stenosis before surgery or transcatheter aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "G. Pulignano" 1 => "M.M. Gulizia" 2 => "S. Baldasseroni" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/sux012" "Revista" => array:7 [ "tituloSerie" => "Eur Heart J Suppl" "fecha" => "2017" "volumen" => "19" "numero" => "Suppl. D" "paginaInicial" => "D354" "paginaFinal" => "D369" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28751850" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0100" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT Registry" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D.R. Holmes Jr." 1 => "R.A. Nishimura" 2 => "F.L. Grover" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2015.10.021" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2015" "volumen" => "66" "paginaInicial" => "2813" "paginaFinal" => "2823" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26652232" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0105" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advantages of a prospective multidisciplinary approach in transcatheter aortic valve implantation: eight years of experience" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "C. Costa" 1 => "R. Campante Teles" 2 => "R. Brito" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.repc.2016.11.015" "Revista" => array:7 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2017" "volumen" => "36" "paginaInicial" => "809" "paginaFinal" => "818" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29153618" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0264410X15011640" "estado" => "S300" "issn" => "0264410X" ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0110" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Value of the “TAVI2-SCORe” versus surgical risk scores for prediction of one year mortality in 511 patients who underwent transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Debonnaire" 1 => "L. Fusini" 2 => "R. Wolterbeek" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2014.10.029" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2015" "volumen" => "115" "paginaInicial" => "234" "paginaFinal" => "242" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25432413" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0115" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predicting early and late mortality after transcatheter aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J.B. Hermiller Jr." 1 => "S.J. Yakubov" 2 => "M.J. Reardon" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jacc.2016.04.057" "Revista" => array:6 [ "tituloSerie" => "J Am Coll Cardiol" "fecha" => "2016" "volumen" => "68" "paginaInicial" => "343" "paginaFinal" => "352" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27443429" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0120" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A simple risk tool (the OBSERVANT score) for prediction of 30-day mortality after transcatheter aortic valve replacement" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Capodanno" 1 => "M. Barbanti" 2 => "C. Tamburino" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.amjcard.2014.03.014" "Revista" => array:6 [ "tituloSerie" => "Am J Cardiol" "fecha" => "2014" "volumen" => "113" "paginaInicial" => "1851" "paginaFinal" => "1858" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24837264" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0125" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "TAVI or No TAVI: identifying patients unlikely to benefit from transcatheter aortic valve implantation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "R. Puri" 1 => "B. Iung" 2 => "D.J. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/eurheartj/ehv756" "Revista" => array:7 [ "tituloSerie" => "Eur Heart J" "fecha" => "2016" "volumen" => "37" "paginaInicial" => "2217" "paginaFinal" => "2225" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26819226" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673615000422" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0130" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Implantação de válvula aórtica percutânea - preditores de “futilidade”" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Gonçalves Teixeira" 1 => "J.G. Almeida" 2 => "A.R. Barbosa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Port Cardiol" "fecha" => "2017" "volumen" => "36" "numero" => "Espec Congr" "paginaInicial" => "23" ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/08702551/0000003600000011/v2_201801180628/S0870255117307965/v2_201801180628/en/main.assets" "Apartado" => array:4 [ "identificador" => "29261" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Artigos Originais" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/08702551/0000003600000011/v2_201801180628/S0870255117307965/v2_201801180628/en/main.pdf?idApp=UINPBA00004E&text.app=https://revportcardiol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117307965?idApp=UINPBA00004E" ]
| Ano/Mês | Html | Total | |
|---|---|---|---|
| 2024 Novembro | 6 | 2 | 8 |
| 2024 Outubro | 39 | 29 | 68 |
| 2024 Setembro | 53 | 29 | 82 |
| 2024 Agosto | 47 | 29 | 76 |
| 2024 Julho | 48 | 24 | 72 |
| 2024 Junho | 36 | 30 | 66 |
| 2024 Maio | 48 | 17 | 65 |
| 2024 Abril | 47 | 27 | 74 |
| 2024 Maro | 40 | 25 | 65 |
| 2024 Fevereiro | 53 | 17 | 70 |
| 2024 Janeiro | 43 | 32 | 75 |
| 2023 Dezembro | 50 | 33 | 83 |
| 2023 Novembro | 57 | 42 | 99 |
| 2023 Outubro | 41 | 11 | 52 |
| 2023 Setembro | 50 | 21 | 71 |
| 2023 Agosto | 67 | 21 | 88 |
| 2023 Julho | 41 | 5 | 46 |
| 2023 Junho | 47 | 10 | 57 |
| 2023 Maio | 81 | 33 | 114 |
| 2023 Abril | 45 | 7 | 52 |
| 2023 Maro | 66 | 26 | 92 |
| 2023 Fevereiro | 53 | 22 | 75 |
| 2023 Janeiro | 38 | 13 | 51 |
| 2022 Dezembro | 63 | 31 | 94 |
| 2022 Novembro | 88 | 47 | 135 |
| 2022 Outubro | 75 | 33 | 108 |
| 2022 Setembro | 61 | 40 | 101 |
| 2022 Agosto | 68 | 33 | 101 |
| 2022 Julho | 61 | 50 | 111 |
| 2022 Junho | 49 | 26 | 75 |
| 2022 Maio | 48 | 33 | 81 |
| 2022 Abril | 63 | 38 | 101 |
| 2022 Maro | 55 | 58 | 113 |
| 2022 Fevereiro | 53 | 45 | 98 |
| 2022 Janeiro | 51 | 37 | 88 |
| 2021 Dezembro | 40 | 41 | 81 |
| 2021 Novembro | 36 | 32 | 68 |
| 2021 Outubro | 59 | 50 | 109 |
| 2021 Setembro | 58 | 33 | 91 |
| 2021 Agosto | 47 | 33 | 80 |
| 2021 Julho | 23 | 25 | 48 |
| 2021 Junho | 34 | 25 | 59 |
| 2021 Maio | 33 | 38 | 71 |
| 2021 Abril | 39 | 38 | 77 |
| 2021 Maro | 83 | 33 | 116 |
| 2021 Fevereiro | 91 | 17 | 108 |
| 2021 Janeiro | 49 | 15 | 64 |
| 2020 Dezembro | 46 | 12 | 58 |
| 2020 Novembro | 53 | 15 | 68 |
| 2020 Outubro | 53 | 8 | 61 |
| 2020 Setembro | 63 | 18 | 81 |
| 2020 Agosto | 39 | 15 | 54 |
| 2020 Julho | 51 | 14 | 65 |
| 2020 Junho | 45 | 21 | 66 |
| 2020 Maio | 42 | 4 | 46 |
| 2020 Abril | 41 | 23 | 64 |
| 2020 Maro | 37 | 13 | 50 |
| 2020 Fevereiro | 100 | 32 | 132 |
| 2020 Janeiro | 21 | 6 | 27 |
| 2019 Dezembro | 23 | 8 | 31 |
| 2019 Novembro | 37 | 10 | 47 |
| 2019 Outubro | 28 | 7 | 35 |
| 2019 Setembro | 19 | 8 | 27 |
| 2019 Agosto | 24 | 11 | 35 |
| 2019 Julho | 29 | 16 | 45 |
| 2019 Junho | 33 | 11 | 44 |
| 2019 Maio | 41 | 14 | 55 |
| 2019 Abril | 25 | 12 | 37 |
| 2019 Maro | 103 | 11 | 114 |
| 2019 Fevereiro | 67 | 19 | 86 |
| 2019 Janeiro | 49 | 9 | 58 |
| 2018 Dezembro | 27 | 11 | 38 |
| 2018 Novembro | 56 | 13 | 69 |
| 2018 Outubro | 104 | 26 | 130 |
| 2018 Setembro | 31 | 9 | 40 |
| 2018 Agosto | 29 | 10 | 39 |
| 2018 Julho | 10 | 5 | 15 |
| 2018 Junho | 22 | 8 | 30 |
| 2018 Maio | 20 | 8 | 28 |
| 2018 Abril | 29 | 12 | 41 |
| 2018 Maro | 35 | 7 | 42 |
| 2018 Fevereiro | 24 | 6 | 30 |
| 2018 Janeiro | 30 | 15 | 45 |
| 2017 Dezembro | 58 | 39 | 97 |
| 2017 Novembro | 2 | 8 | 10 |
Mostrar tudo
