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

Abstract


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.

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