TAVI Program in a Center Without On-Site Cardiac Surgical Department

Background: Aortic stenosis (AS) is the most common valvular heart disease, associated with poor outcomes if left untreated. Current guidelines recommend that transcatheter aortic valve implantation (TAVI) procedures be performed in hospitals with an on-site cardiac surgery unit due to potential complications requiring surgical intervention. This study aims to evaluate the feasibility and clinical outcomes of implementing a TAVI program at a cardiology department without an on-site cardiac surgery department, in collaboration with a remote hospital for surgical backup. Methods: The TAVI program involved pre- and post-procedural evaluations conducted at Meir Medical Center (Kfar Saba, Israel) with a remote surgical team available. The study population included 149 consecutive patients with severe aortic stenosis treated at the Meir valve clinic between November 2019 and December 2023. Procedures were performed by the center's interventional cardiology team. Results: The mean age of the 149 patients was 80 ± 6 years, and 75 (50%) were female. The average STS score was 4.3 and the EuroSCORE II was 3.1. Among the patients, 68 (45%) were classified as New York Heart Association (NYHA) class III-IV. Valve types used included Acurate-neo 2 (57 patients, 38%), Sapien-3 (43 patients, 28%), Evolut-PRO (41 patients, 27%), and Navitor (7 patients, 4%). There were no cases of moderate to severe paravalvular leak, no elevated post-implantation gradients, and no need for urgent cardiac surgery. One case of valve embolization was successfully managed percutaneously during the procedure. In-hospital follow-up revealed no deaths and only one major vascular complication. At one-year follow-up, six patients had died, with only one death attributed to cardiac causes. Conclusions: This study demonstrates that the transfemoral TAVI procedure can be safely and effectively performed in a cardiology department without an on-site cardiac surgery unit, provided there is collaboration with a remote surgical center. These findings suggest that expanding TAVI programs to centers without on-site cardiac surgery could increase access to this life-saving treatment for aortic stenosis.