Can Transcatheter Aortic Valve Implantation (TAVI) Be Performed at Institutions Without On-Site Cardiac Surgery Departments?

Transcatheter aortic valve implantation [TAVI] represents a paradigm shift in therapeutic options for patients with severe aortic stenosis [AS]. In less than 20 years, TAVI has rapidly disseminated to include a significant pro-portion of AS patients. The number of AS patients needing TAVI is expected to further increase. Since there is a limited number of centers performing TAVI, wait times are expected to increase. This might have a critical impact of AS patient life as mortality rate of AS patients awaiting TAVI, is substantial, ranging from 2 to 10%. With time, as more patients were treated, improved experience, better imaging and devices, this technology be-came safer with more reliable results. Today most TAVI complications are related to vascular access [4-6%] and there is less need for emergency thoracic bail out [0.2-0.5%]. In this review, we summarize the prognosis while waiting, the outcomes of patients undergoing TAVI at institu-tions without on-site cardiac surgery departments and the data describing rates and outcomes of TAVI patients requiring treatment of intra-procedural life-threatening complications. Similar to coronary interventions in the past, TAVI should be considered also in centers without on-site cardiac surgery departments under certain con-ditions such as, experienced operators, heart team discussion, well established imaging modalities, skilled and qualified support personal, and adequate pre-and post-care facility.(c) 2021 Elsevier Inc. All rights reserved.

Automated summary

Transcatheter aortic valve implantation (TAVI) is a paradigm shift in the treatment of severe aortic stenosis patients. The number of patients requiring TAVI is expected to increase, leading to longer wait times. The safety and reliability of TAVI have improved over time with advancements in technology and experience.