Long-term clinical outcomes of TAVI in hospitals without on-site cardiac surgery: insights from the MURGIA-TAVI Registry.
Transcatheter aortic valve implantation (TAVI) is the standard of care for elderly (≥70 years) or high-risk patients with severe aortic stenosis, yet current guidelines recommend its performance only in Heart Valve Centres with on-site cardiac surgery. This study evaluated procedural safety and long-term outcomes of TAVI performed in selected non-surgical centres.
We retrospectively analysed 186 consecutive patients undergoing TAVI at 'F. Miulli' Hospital between 2016 and 2024, enrolled in the MURGIA-TAVI Registry. The programme operated without institutional on-site cardiac surgery, supported by a structured Heart Team approach and a visiting surgical back-up. Outcomes were assessed according to Valve Academic Research Consortium-3 definitions and survival was evaluated up to 5 years.
Among 186 patients (mean age 82 years; STS score 7%), transfemoral access was used in 93%. Technical success was 98.9%, with no intraprocedural deaths. Conversion to emergent cardiac surgery occurred in two patients (1.1%); both survived at 30 days. In-hospital mortality was 1.6%, never valve-related. Major complications included cardiac tamponade (1.6%), major bleeding (2.2%) and major vascular complications (1.1%). At 1 year, mortality was 15.6% with no valve-related deaths, and valve dysfunction occurred in 1.9% of patients. Five-year survival reached 52.5%. Outcomes, including rates of emergent cardiac surgery, were comparable to those reported in published registries from centres without institutional on-site cardiac surgery.
Our findings suggest that TAVI can be safely performed in selected hospitals without on-site cardiac surgery within a structured Heart Team framework and a visiting surgical back-up, potentially expanding access, shortening waiting times, and meeting the growing demand for TAVI.
We retrospectively analysed 186 consecutive patients undergoing TAVI at 'F. Miulli' Hospital between 2016 and 2024, enrolled in the MURGIA-TAVI Registry. The programme operated without institutional on-site cardiac surgery, supported by a structured Heart Team approach and a visiting surgical back-up. Outcomes were assessed according to Valve Academic Research Consortium-3 definitions and survival was evaluated up to 5 years.
Among 186 patients (mean age 82 years; STS score 7%), transfemoral access was used in 93%. Technical success was 98.9%, with no intraprocedural deaths. Conversion to emergent cardiac surgery occurred in two patients (1.1%); both survived at 30 days. In-hospital mortality was 1.6%, never valve-related. Major complications included cardiac tamponade (1.6%), major bleeding (2.2%) and major vascular complications (1.1%). At 1 year, mortality was 15.6% with no valve-related deaths, and valve dysfunction occurred in 1.9% of patients. Five-year survival reached 52.5%. Outcomes, including rates of emergent cardiac surgery, were comparable to those reported in published registries from centres without institutional on-site cardiac surgery.
Our findings suggest that TAVI can be safely performed in selected hospitals without on-site cardiac surgery within a structured Heart Team framework and a visiting surgical back-up, potentially expanding access, shortening waiting times, and meeting the growing demand for TAVI.
Authors
Mancini Mancini, Scarcia Scarcia, Basile Basile, Martimucci Martimucci, Guida Guida, Casamassima Casamassima, Xhelo Xhelo, Speziale Speziale, Visicchio Visicchio, Massaro Massaro, Magnesa Magnesa, Langialonga Langialonga, Paradies Paradies, Iorio Iorio, Grimaldi Grimaldi
View on Pubmed