Poor outcome in severe aortic stenosis patients diagnosed in centers without on-site cardiac surgery awaiting TAVI

Introduction: Transcatheter aortic valve implantation (TAVI) is now the standard treatment for severe aortic stenosis (AS) in symptomatic patients, and its indications are expanding to lower-risk patients. Peri procedural mortality rate nowadays is below 1%. Current guidelines mandate TAVI to be performed at hospitals with both cardiology and on-site cardiac surgery (CS) departments.

Objectives: The objective of this study was to analyze the prognosis of AS patients diagnosed in hospitals without on-site CS and referred for TAVI to an hospital with on-site CS.

Methods: During a six month period [May-November 2019] we collected data of all severe AS patients diagnosed in 9-medical centers without on-site CS and referred for TAVI.

Results: Overall, there were 203 AS patients referred for TAVI in a six month period. Waiting time ranged between 0.5-3 months. The mortality rate during this waiting period was 4.9% [10 out of 203 patients] (Table).

Discussion: TAVI has become a safer procedure with reduced morbidity and mortality. Most of the complications today are related to access site complications, which can be treated in any hospital, also those without CS. The number of patients with severe AS suitable for TAVI is predicted to increase significantly. The mortality rate we found was five times higher than if those patients underwent TAVI immediately.

Conclusions: These preliminary data in a modest number of severe AS patients suggest that there is a need of performing TAVI in appropriately selected patients, under specific conditions, also at hospitals without cardiac surgery.