Abstract 17784: Self-expandable Transcatheter Aortic Valves Programs In Centres Without On Site Cardiac Surgery: Data From A Multicentre Registry
Introduction: Current European and American guidelines recommend TAVI procedures only in centres with on site cardiac surgery, due to the possibility of the neediness for emergent open-surgery conversion. The improvements of technology and the higher experience of implant centres have become this scenario in an anecdotal possibility, mainly with the self-expandable devices.
Methods: We assess the features and the course of patients undergoing TAVI in six centres without on site cardiac surgery but with the possibility for transfer to a reference centre for urgent cardiac surgery. All procedures were accepted by each heart-team with participation of each cardiac surgeons of reference. VARC-2 criteria were used.
Results: A total of 210 patients (81.7 ± 5 years; 48% male; mean STS score 5.1 ± 3%; mean EUROSCORE 18.1 ± 10%, 11% porcelain aorta) were included in this prospective registry. The mean distance from the cardiac surgery centre of reference was 66 Km (0.2-154 Km). The 26% of the procedures were performed under general anaesthesia and the procedure was fully percutaneous in 91%. The success of the procedure was achieved in 96.7%. Regarding the course, the incidence of major bleeding and major vascular complications was 8.6% and 3.8% respectively; mortality at 72 hours, in-hospital and at 30 days was 1.9%, 4.8% and 3.9 % respectively (1.9% cardiovascular and 2% non-cardiovascular death). No annular ruptures or aortic dissections were described. There were 4 cardiac perforations and 3 coronary occlusions (1 death), which were percutaneously managed. No transferring for urgent or elective surgery occurred. One-year survival was 83.5%.
Conclusions: In this multicentre registry, outcomes at discharge, 30-day and 1 year are similar to those published in centres with on site cardiac surgery. Nowadays, with the improvements of self-expandable devices and the higher experience on the selection of patients, the restriction of TAVI interventions only for centres with on site cardiac surgery does not seem reasonable.
Author Disclosures: J.G. Cordoba-Soriano: None. J. Jimenez-Mazuecos: None. J. Roa-Garrido: None. J.F. Diaz Fernandez: None. G. Gallego-Sánchez: None. A. Gutierrez Diez: None. P. Perez-Santigosa: None. L.F. Hernando: None. F.J. Sánchez-Burguillos: None. J. Botas: None. R. Lazaro: None. J. Herrero-Garibi: None. F. Valencia-Serrano: None. J. Robles: None.
- © 2016 by American Heart Association, Inc.