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Decentralizing is the key: TAVI without cardiac surgery backup - a meta-analysis
Session:
Sessão de Posters 31 - Intervenção transcateter na válvula aórtica: acesso, futilidade e anatomia complexa
Speaker:
Marta Paralta De Figueiredo
Congress:
CPC 2026
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Marta Paralta de Figueiredo; Rafael Viana; Rita Louro; Raquel Silva; António Almeida; Manuel Trinca
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Background: </strong>Aortic stenosis (AS) is the most common valvular heart disease requiring intervention, with prevalence rising alongside global aging trends. Transcatheter aortic valve implantation (TAVI) has revolutionized AS management and expanded to broader populations. Current guidelines recommend TAVI only in centers with on-site cardiac surgery (CS) backup. However, procedural advancements have reduced the need for emergent cardiac surgery (ECS), prompting debate over this requirement. This meta-analysis evaluated the safety and feasibility of TAVI performed in centers without immediate CS backup.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> A systematic review and meta-analysis were conducted following the PRISMA guidelines. The protocol was registered with PROSPERO (CRD420251044095). PubMed, CENTRAL, and Scopus were systematically searched through April 2025. Studies comparing outcomes of TAVI performed with and without on-site CS or reporting outcomes in non-CS centers were included. The outcomes were in-hospital mortality, 30-day death, ECS, stroke, and permanent pacemaker implantation (PPI). Meta-analyses of comparative studies and pooled proportions were performed using random-effects models.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> Five observational studies were analyzed, including 21654 patients (19373 with and 2281 without on-site CS). No significant difference in in-hospital mortality was observed between groups (RR 1.1, 95% CI [0.6–1.9], p=0.8). Thirty-day mortality was also similar (RR 1.2, 95% CI [0.5–2.6], p=0.72). ECS was rare (0%, 95% CI [0–2]), with a pooled RR of 0.8 (95% CI [0.2–2.4], p=0.7). Stroke rates did not differ (RR 1.1, 95% CI 0.8–1.5), and no difference in PPI was found (RR 1.2, 95% CI 0.6–2.3), though heterogeneity was high for this outcome. Pooled in-hospital mortality in non-surgical centers was 4% (95% CI 3–5%), and 30-day mortality was 6% (95% CI 4–7%). Sensitivity analyses in propensity score–matched populations confirmed findings with reduced heterogeneity and consistent results.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusions</strong>: TAVI performed in centers without on-site CS appears safe, with outcomes comparable to those at surgical centers. These findings support a potential reappraisal of current guideline restrictions to improve access and equity in TAVI delivery in order to shorten waitlists and reduce worsening aortic stenosis mortality.</span></span></p>
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