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Transcatheter Aortic Valve Implantation Without Cardiac Surgery Backup: First National Single-Center Experience Assessing Safety and Efficacy Outcomes
Session:
SESSÃO DE COMUNICAÇÕES ORAIS 08 – OTIMIZAR RESULTADOS NA TAVI: PERFIL DO DOENTE, TÉCNICAS E VÁLVULAS
Speaker:
Antonio Maria Rocha de Almeida
Congress:
CPC 2025
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
António Maria Rocha De Almeida; Marta Paralta Figueiredo; Renato Fernandes; Ângela Bento; David Neves; Diogo Brás; Rita Rocha; Manuel Trinca; Álvaro Laranjeira Santos; Lino Patrício
Abstract
<p style="text-align:justify"><strong>Introduction</strong></p> <p style="text-align:justify">Transcatheter aortic valve implantation (TAVI) is traditionally performed with cardiac surgery backup onsite. Yet, TAVI development has enabled it to be conducted safely outside these centers. This study aims to describe our experience and the outcomes of TAVI in this paradigm shift to a center without a cardiac surgery backup onsite.</p> <p style="text-align:justify"><strong>Methods</strong></p> <p style="text-align:justify">A retrospective cohort of 300 TAVI patients at a center without cardiac surgery backup onsite between 2020 and 2024 was analyzed. The primary endpoints were procedural death, 30-day mortality, and stroke. Secondary outcomes included in-hospital mortality, length of hospital stay, surgery-required complications, and permanent pacemaker implantation.</p> <p style="text-align:justify"><strong>Results</strong></p> <p style="text-align:justify">300 patients underwent TAVI, with a mean age of 82±5 years, and 54% female. The median STS risk score was 3,8 [2.3–6.6], with 20% classified as high-risk patients (STS > 8). Baseline echocardiographic characteristics were a mean aortic gradient of 48±14mmHg, left ventricular ejection fraction of 57±12%, and systolic pulmonary artery pressure of 38±14mmHg. The mean aortic valve calcium score was 2912±1572 UA. The bicuspid aortic valve was present in 6% of patients (n=18), and valve-in-valve procedures were performed in 7 cases (2.3%). Compared with the national TAVI registry, there were no significant differences in baseline characteristics. Most procedures were elective (83%, n=249). Femoral access was preferred in 99% of cases, with the contralateral femoral artery as secondary access in 90%. Self-expandable Evolut CoreValve was used in 96% of procedures.</p> <p style="text-align:justify">Procedural success rate was 99% (n=298). In-hospital and 30-day mortality was 2% and 3,7%, respectively; stroke occurred in 2.7%, and a pacemaker was required in 20%. Tamponade occurred in 0.6% of cases (n=2), and surgical intervention in 0,3% (n=1). There was 8% of major bleeding and vascular complication rates. There were no cases of coronary obstruction, the need for extra-circulatory support, or TAVI in TAVI deployment as a bailout. The median hospital stay was 3 days, 2 at the ICU level. Significant symptomatic improvement was verified in 91% of the cases. After 1 year, the mortality rate was 12%. There were no significant differences in outcomes compared to the TAVI national registry results and in a center without cardiac surgery onsite (Table 1).</p> <p style="text-align:justify"><strong>Conclusion</strong></p> <p style="text-align:justify">This first national single-center experience of TAVI performed without cardiac surgery backup demonstrates excellent safety and efficacy outcomes. Procedural success was achieved in 99% of cases, with low in-hospital and 30-day mortality rates, stroke, and major complications. One-year survival was comparable to outcomes from centers with onsite surgical backup. These findings suggest that TAVI can be safely performed in appropriately equipped centers without immediate access to cardiac surgery, potentially broadening the accessibility of this procedure. </p>
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