Multidisciplinary team–guided management of severe aortic stenosis: five-year outcomes following TAVI versus conservative treatment

Abstract

Objective: Multidisciplinary team (MDT) meetings are central to treatment decisions in aortic stenosis (AS), particularly for borderline or high-risk patients. This study evaluates long-term, real-world outcomes according to MDT selected management strategy within routine clinical practice in this clinically important patient group. Methods: We conducted a retrospective cohort study of all patients with severe AS discussed at a TAVI MDT at a tertiary UK centre between January 2014 and December 2016. Patients were categorised as TAVI or non-TAVI (conservatively managed). Demographic, clinical, and frailty data were collected, including Charlson Comorbidity Index (CCI), Clinical Frailty Scale (CFS), and number of prescribed medications. Survival was analysed using Kaplan–Meier estimates and Cox proportional hazards modelling adjusted for age, sex, frailty, comorbidity burden, and medication count. Results: A total of 373 patients were included (TAVI = 178; non-TAVI = 195). Patients undergoing TAVI were younger (81.3 vs 83.5 years; p = 0.01) and less frail (CFS 3.9 vs 4.9; p < 0.01). Survival at one, two, and five years was significantly higher following TAVI (87.6%, 74.7%, 44.9%) compared with conservative management (60.8%, 44.2%, 12.1%; p <0.001). Median survival was 53 months after TAVI versus 20 months without intervention. On multivariable analysis, TAVI was independently associated with reduced mortality (HR 0.38, 95% CI 0.28–0.50; p <0.001). Conclusions: In patients with severe AS discussed at MDT, TAVI was associated with a substantial and durable survival advantage compared with conservative management. These findings highlight the poor prognosis of untreated severe AS and support systematic inclusion of conservatively managed patients in interventional registries to better inform MDT deliberation and shared decision-making