Is Heart Team Fundamental to Aortic Stenosis Transcatheter Treatment?

Demographic projections have shown that the contingent of elderly people in Brazil will double within the next 20 years, with a consequent increase in the prevalence of aging-related diseases, such as degenerative aortic valve stenosis (AoS), diagnosed in 3% to 5% of the population older than 75 yeas ^, . New modalities of treatment for AoS have been recently developed, mainly represented by the transcatheter implantation of aortic prosthesis (TAVI – Transcatheter Aortic Valve Implantation), which has become a therapeutic option for patients whose conventional surgical treatment is not feasible. In the current scenario, characterized by the high demand of the increasing elderly population, the availability of new treatment methods provides clinical expertise for the accurate diagnosis of heart valve disease, assessment of the comorbidities and risks of interventions, in addition to the rationalization of resources, considering the complexity and high costs involved in TAVI.

Clinical practice has shown that the adequate selection of the best therapeutic method for high surgical-risk AoS requires multidisciplinary medical interaction, contemplating all the patients’ biopsychosocial characteristics. Thus, several medical centers have continuously incorporated the ‘Heart Team’ concept for decision-making. The Heart Team, a group composed by different specialists involved in managing heart valve disease, gathers opinions for the individualized analysis of those patients, from eligibility criteria and technical adequacy of the procedure to post-TAVI care. Each cardiological sub-specialty also plays particular roles in the procedure performance. The clinical cardiologist is responsible for patients’ selection and indication and for pre-and post-procedure follow-up. The cardiovascular surgeon is responsible for performing the transaortic and transapical procedure, helping with the transfemoral approach, and treating possible complications. The radiologist is responsible for assessing the access path and valve diameters, and helping choosing the adequate prosthesis. The echocardiographer is responsible for the anatomical and functional characterization of the valve disease and intraoperative assessment of the adequate position of the prosthesis and post-procedure complications. The interventional cardiologist is responsible for indicating the procedure and performing it. In addition, the Heart Team also comprises other professionals, such as nurses, physical therapists, nutritionists, and psychologists. Worldwide, there is an increasing incorporation of the Heart Team into cardiological centers, in accordance with the considerations of the last guidelines on heart valve diseases ^, . There is consensus about not encouraging the performance of TAVI at sites lacking a Heart Team, which emphasizes the importance of institutional alignment with the new recommendations.

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