Transcatheter aortic valve implantation without immediate cardiac surgery backup. A single-center retrospective analysis.

Authors

António Rocha de Almeida, Renato Fernandes, Ângela Bento, David Neves, Diogo Brás, Gustavo Mendes, Rita Rocha, Marta Paralta Figueiredo, Rafael Viana, Rita Louro, Álvaro Laranjeira Santos, Lino Patrício

Published in

REC, interventional cardiology. Volume 8. Issue 2. Pages 72-78. Epub Nov 03, 2025.

Abstract

Transcatheter aortic valve implantation (TAVI) is traditionally performed with on-site cardiac surgery (CS) backup. However, procedural advances enabled TAVI to be performed safely without immediate CS backup. This study describes our single-center experience with TAVI performed in a center without on-site CS backup.
We conducted a retrospective analysis of the first 300 patients undergoing TAVI without on-site CS backup between 2020 and 2024. The primary endpoint was 30-day mortality. Secondary endpoints included procedural and in-hospital mortality, stroke, emergency cardiac surgery (ECS), vascular complications, major hemorrhage, and pacemaker implantation. Outcomes were compared with those from the Portuguese national TAVI registry.
The cohort mean age was 82±5 years (54% women). The median STS risk score was 3.8 [IQR, 2.3-6.6], with 17% high-risk patients (STS > 8). Most procedures were elective (83%). Transfemoral access was used in 99% of cases, and self-expandable valves were implanted in 95%. The 30-day mortality rate was 3.7% (n = 11), while stroke occurred in 2.7% (n = 8). The procedural survival rate was 99% (n = 298). No cases of ECS occurred (n = 0), coronary obstruction, TAVI-in-TAVI deployment as a bailout, or valve embolization were reported. Pericardial tamponade occurred in 0.7% of cases (n = 2). Major hemorrhage and vascular complications occurred in 8%, and pacemaker implantation in 20%. The 1-year mortality rate was 12%, with 4% attributed to cardiovascular causes; among survivors, and 91% reported symptomatic improvement. There were no significant differences in outcomes vs the results from the TAVI national registry.
TAVI was safely and effectively performed without on-site CS, including emergency and complex cases. The non-ECS rate and outcomes comparable to national benchmarks support the feasibility of TAVI in selected non-CS centers. In this context, expanding TAVI access may reduce waiting times and improve the management of severe aortic stenosis while maintaining high procedural quality.

PMID:
42745734
Bibliographic data and abstract were imported from PubMed on 16 Sep 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.