{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:35:22Z","timestamp":1788284122496,"version":"build-2803163510"},"reference-count":22,"publisher":"Wiley","license":[{"start":{"date-parts":[[2022,6,25]],"date-time":"2022-06-25T00:00:00Z","timestamp":1656115200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100007588","name":"Washington State University","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007588","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Interventional Cardiology"],"published-print":{"date-parts":[[2022,6,25]]},"abstract":"<jats:p>Objectives. This study was conducted to determine why heart teams recommended transcatheter aortic valve replacement (TAVR) versus surgical AVR (SAVR) for patients at low predicted risk of mortality (PROM) and describe outcomes of these cases. Background. Historically, referral to TAVR was based predominately on the Society of Thoracic Surgeons (STS) risk model\u2019s PROM &gt;3%. In selected cases, heart teams had latitude to overrule these scores. The clinical reasons and outcomes for these cases are unclear. Methods. Retrospective data were gathered for all TAVR and SAVR cases conducted by 9 hospitals between 2013 and 2017. Results. Cases included TAVR patients with STS PROM &gt;3% (n\u2009=\u20092,711) and \u22643% (n\u2009=\u2009415) and SAVR with STS PROM \u22643% (n\u2009=\u20091,438). Leading reasons for recommending TAVR in the PROM \u22643% group were frailty (57%), hostile chest (22%), severe lung disease (16%), and morbid obesity (13%), and 44% of cases had multiple reasons. Most postoperative and 30-day outcomes were similar between TAVR groups, but the STS PROM \u22643% group had a one-day shorter length of stay (2.5\u2009\u00b1\u20093.4 vs. 3.5\u2009\u00b1\u20094.7\u2009days; <jats:inline-formula>\n                     <a:math xmlns:a=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M1\">\n                        <a:mi>p<\/a:mi>\n                        <a:mo>\u2264<\/a:mo>\n                        <a:mn>0.001<\/a:mn>\n                     <\/a:math>\n                  <\/jats:inline-formula>) and higher one-year survival (91.6% vs. 86.0%, <jats:inline-formula>\n                     <c:math xmlns:c=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M2\">\n                        <c:mi>p<\/c:mi>\n                        <c:mo>=<\/c:mo>\n                        <c:mn>0.002<\/c:mn>\n                     <\/c:math>\n                  <\/jats:inline-formula>). In patients with STS PROM \u22643%, 30-day mortality was higher for TAVR versus SAVR (2.0% vs. 0.6%; <jats:inline-formula>\n                     <e:math xmlns:e=\"http:\/\/www.w3.org\/1998\/Math\/MathML\" id=\"M3\">\n                        <e:mi>p<\/e:mi>\n                        <e:mo>&lt;<\/e:mo>\n                        <e:mn>0.001<\/e:mn>\n                     <\/e:math>\n                  <\/jats:inline-formula>). Conclusions. Heart teams recommended TAVR in patients with STS PROM \u22643% primarily due to frailty, hostile chest, severe lung disease, and\/or morbid obesity. Similar postoperative outcomes between these patients and those with STS PROM &gt;3% suggest that decisions to overrule STS PROM \u22643% were merited and may have reduced SAVR 30-day mortality rate.<\/jats:p>","DOI":"10.1155\/2022\/9926423","type":"journal-article","created":{"date-parts":[[2022,6,25]],"date-time":"2022-06-25T22:50:06Z","timestamp":1656197406000},"page":"1-9","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Factors and Outcomes When Real-World Heart Teams Overruled STS Risk Scores in TAVR Cases"],"prefix":"10.1155","volume":"2022","author":[{"given":"Jackson M.","family":"King","sequence":"first","affiliation":[{"name":"Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan T.","family":"Black","sequence":"additional","affiliation":[{"name":"Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruyun","family":"Jin","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence St. Joseph Health, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary L.","family":"Grunkemeier","sequence":"additional","affiliation":[{"name":"Center for Cardiovascular Analytics, Research and Data Science, Providence Heart Institute, Providence St. Joseph Health, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Branden R.","family":"Reynolds","sequence":"additional","affiliation":[{"name":"Providence Sacred Heart Medical Center, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brydan D.","family":"Curtis","sequence":"additional","affiliation":[{"name":"Providence Sacred Heart Medical Center, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert W.","family":"Hodson","sequence":"additional","affiliation":[{"name":"Providence St. Vincent Medical Center, Portland, OR, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erika A.","family":"Strehl","sequence":"additional","affiliation":[{"name":"Heart Institute, Providence St. Joseph Health, Renton, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer A.","family":"Gafoor","sequence":"additional","affiliation":[{"name":"Swedish Heart and Vascular Institute, Swedish Medical Center, Seattle, WA, USA"},{"name":"Cardiovascular Center Frankfurt, Frankfurt, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew D.","family":"Forrester","sequence":"additional","affiliation":[{"name":"Providence Sacred Heart Medical Center, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3929-3317","authenticated-orcid":true,"given":"Emily J.","family":"Cox","sequence":"additional","affiliation":[{"name":"Providence Medical Research Center, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7353-5450","authenticated-orcid":true,"given":"Michael E.","family":"Ring","sequence":"additional","affiliation":[{"name":"Providence Sacred Heart Medical Center, Spokane, WA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","reference":[{"key":"1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.07.002"},{"key":"2","doi-asserted-by":"publisher","DOI":"10.2217\/fca-2019-0011"},{"key":"3","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1514616"},{"key":"4","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1700456"},{"key":"5","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1816885"},{"key":"6","doi-asserted-by":"publisher","DOI":"10.1056\/nejmoa1814052"},{"key":"7","article-title":"Fda expands indication for several transcatheter heart valves to patients at low risk for death or major complications associated with open-heart surgery","author":"FDA News Release","year":"2022"},{"key":"8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.03.060"},{"key":"9","article-title":"Adult cardiac surgery Database. the society of thoracic Surgeons","author":"The STS","year":"2022"},{"key":"10","doi-asserted-by":"publisher","DOI":"10.1002\/sim.1070"},{"key":"11","doi-asserted-by":"publisher","DOI":"10.1214\/aos\/1176350951"},{"key":"12","volume-title":"A Language and Environment for Statistical Computing","author":"R Foundation for Statistical Computing","year":"2018"},{"key":"13","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-18-00460"},{"key":"14","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.06.024"},{"key":"15","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2017.01.35"},{"key":"16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2014.07.087"},{"key":"17","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamcollsurg.2013.06.012"},{"key":"18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.01.242"},{"key":"19","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.03.002"},{"key":"20","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2018.03.003"},{"key":"21","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2009.05.056"},{"key":"22","doi-asserted-by":"publisher","DOI":"10.4244\/eij-d-17-00421"}],"container-title":["Journal of Interventional Cardiology"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/downloads.hindawi.com\/journals\/jitc\/2022\/9926423.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jitc\/2022\/9926423.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/downloads.hindawi.com\/journals\/jitc\/2022\/9926423.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,25]],"date-time":"2022-06-25T22:50:08Z","timestamp":1656197408000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.hindawi.com\/journals\/jitc\/2022\/9926423\/"}},"subtitle":[],"editor":[{"given":"Leo","family":"Timmers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,6,25]]},"references-count":22,"alternative-id":["9926423","9926423"],"URL":"https:\/\/doi.org\/10.1155\/2022\/9926423","relation":{},"ISSN":["1540-8183","0896-4327"],"issn-type":[{"value":"1540-8183","type":"electronic"},{"value":"0896-4327","type":"print"}],"subject":[],"published":{"date-parts":[[2022,6,25]]}}}