Multicenter Experience of Transcatheter Aortic Valve Implantation Stratified by Risk in Latin American Centers

Gerardo Nau, Ezequiel Zaidel, Marcelo Abud, Fernando Cura, Enrique Rivero, Emer Vitor, Dario Echeverri


Introduction: Transcatheter aortic valve implantation (TAVI) has been evaluated in different scenarios of the broad spectrumof patients with severe symptomatic aortic stenosis. The choice of treatment starts through a risk assessment guided by amultidisciplinary team.Purpose: The aim of this study was to analyze the population undergoing TAVI in Latin America according to their risk.Methods: From March 2009 to December 2018, consecutive TAVI procedures registered in the Latin American multicenter registrywere included. The indication of TAVI was made in each case by a multidisciplinary team set up by each center. The population isstratified according to the surgical risk evaluated by the STS-PROM score. Three groups were defined, based on the establishedSTS-PROM cut-off points: high risk (RA, higher 8%), intermediate risk (IR, between 4%-8%) and low risk (RB, lower 4%).Results: 770 patients were included in the analysis, resulting 50,2% female, with a mean age of 81 y/o (IQR 75.6-85.7). 29.8%were included in the AR group (STS-PROM 11 (9.3-16.7), 44% at intermediate risk (STS-PROM 6 (4.8-6.71) and 26.1% atlow risk (STS-PROM 2.7 (2-3.24). The proportion of low-risk patients has increased significantly over the period of inclusion(ptrend 0.011). Femoral access (95%), being percutaneous in 69% of patients. Self-expanding valves were implanted in 80%.23% of the valves were repositionable without differences across the groups. There was no differences in 30-day mortality(RA 10.4%, IR 6.48%, RB 5.9%, p 0.154). Reduction in mortality were observed (RA 13, 7-4.1%, p0.001; RB 11.7-0%; p 0.0023)during the analyzed period.Conclusions: Risk stratification through surgical “scores” continues to represent a very useful guide, however the indicationof TAVI in the real world incorporates other factors not contemplated in the classical score, which modifies our decisions indaily practice.


Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, DeebGM, et al. U.S. Cor eValve Clinical Investigators. Transcatheter aorticvalve replacement with a self expanding prosthesis. N Engl J Med 2014;370:1790-8.

Mack MJ, Leon MB, Smith CR, Miller DC, Moses JW, Tuzcu EM, et al. PARTNER 1 trial investigators. 5-year outcomes of transcatheter aortic valve replacement or surgical aortic valve replacement for high surgical risk patients with aortic stenosis (PARTNER 1): a randomized controlled trial. Lancet 2015;385:2477-84.

Leon MB, Smith CR, Mack MJ, Makkar RR, Svensson LG, Kodali

SK, et al. PART-NER 2 Investigators. Transcatheter or Surgical

Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J

Med 2016;374:1609-20.

Reardon MJ, Van Mieghem NM, Popma JJ, Kleiman NS, Søndergaard L, Mumtaz M, et al. for the SURTAVI Investigators. Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients. N Engl J Med. 2016;374:1609-20.


Thyregod HG, Steinbrüchel DA, Ihlemann N, Nissen H, Kjeldsen

BJ, Petursson P, et al. Transcatheter Versus Surgical Aortic

Valve Replace- ment in Patients With Severe Aortic Valve Stenosis

-Year Results From the All-Comers NOTION Randomized Clinical

Trial. J Am Coll Cardiol 2015;65:2184-94.


Mack MJ, Leon MB, Thourani VH, Makkar R. Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients. N Engl J Med 2019;380:1695-705.

Popma JJ, Deeb M, Yakubov SJ, Mumtaz M. Transcatheter

Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk

Patients. N Engl J Med 2019;380:1706-15.


Consenso Valvulopatías Sociedad Argentina de Cardiología. Rev

Argent Cardiol 2015;83 Supl 2.

Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. ESC Scientific Document Group; 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739-91.

O’Brien SM, Shahian DM, Filardo G, Ferraris VA, Haan CK,

Rich JB, et al; Society of Thoracic Surgeons Quality Measurement

Task Force. The Society of Thoracic Surgeons 2008 cardiac surgery

risk models: part 2-isolated valve surgery. Ann Thorac Surg 2009;


Bonow RO, Carabello BA, Chatterjee K, de Leon AC Jr, Faxon

DP, Freed MD, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2008 focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1998 guidelines for the management of patients with valvular heart disease). Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2008;52:e1-142.

Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol 2012;60:1438-54.

Borracci R, Navia D, Kotowicz V, Machain A, Higa C. Metanálisis sobre la mortalidad hospitalaria del reemplazo valvular aórtico en pacientes con riesgo bajo e intermedio en Argentina. Rev Argent Cardiol 2019;87:280-9.

Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C,

Levang OW, et al. A prospective survey of patientswith valvular

heart disease in Europe. The Euro Heart Survey on Heart Valve

Disease. Eur Heart J 2003;24:1231-43.

Bach DS, Cimino N, Deeb GM. Unoperated patients with severe

aortic stenosis. J Am Coll Cardiol 2007;50:2018-9. https://doi.


Bourguignon T, Bouquiaux-Stablo AL, Candolfi P, Mirza A, Loardi C, May MA, et al. Very long-term outcomes of the Carpentier-Edwards Perimount valve in aortic position. Ann Thorac Surg 2015;99:831-7.

Foroutan F, Guyatt GH, O’Brien K, Bain E, Stein M, Bhagra S, et

al. Prognosis after surgical replacement with a bioprosthetic aortic

valve in patients with severe symptomatic aortic stenosis: systematicreview of observational studies. BMJ 2016;354:i5065.

Durand E, Sokoloff A, Urena-Alcazar M, Chevalier B, Chassaing

S, Didier R, et al. Assessment of Long-Term Structural Deterioration

of Transcatheter Aortic Bioprosthetic Valves Using the New EuropeanDefinition. Circ Cardiovasc Interv 2019;12:e007597.

Eltchaninoff H, Durand E, Avinée G, Tron C, Litzler PY, Bauer

F, et al. Assessment of structural valve deterioration of transcatheter

aortic bioprosthetic balloon-expandable valves using the new European consensus definition. EuroIntervention 2018;14(3):e264-e271.

Kataruka A, Otto CM. Valve durability after transcatheter aortic

valve implantation. J Thorac Dis 2018;10(Suppl 30):S3629-36.

Carroll JD, Vemulapalli S, Dai D, Matsouaka R, Blackstone

E, Edwards F. Procedural Experience for Transcatheter Aortic

Valve Replacement and Relation to Outcomes The STS/ACC TVT

Registry. J Am Coll Cardiol 2017;70:29-41.


Minha S, Waksman R, Satler LP, Torguson R, Alli O, Rihal CS,

et al. Learning curves for transfemoral transcatheter aortic valve

replacement in the PARTNER-I trial: success and safety. Catheter

Cardiovasc Interv. 2016;87:165-75.


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