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

pp. 105-110

Abstract

Background: Transcatheter aortic valve implantation (TAVI) has been evaluated in different scenarios from the wide-spectrum of patients with severe symptomatic aortic stenosis. The choice of the type of treatment is based on risk assessment by a multidisciplinary heart team.

Objective: The aim of this study was to analyze the characteristics of patients undergoing TAVI in Latin America and to evaluate the outcomes of the intervention according to estimated risk.

Methods: Patients from the multicenter Latin American TAVI registry were consecutively included from March 2009 to December 2018. The indication of TAVI was made in each case by a local multidisciplinary team. The STS-PROM score was used to stratify risk in this population. Three groups were defined according to the established cutoff points of the STS-PROM: high risk (HR, > 8%), intermediate risk (IR, 4-8%) and low risk (LR, < 4%).

Results: A total of 770 patients were included in the analysis; mean age was 81 years (IQR 75.6-85.7) and 50.2% were women. Among these patients, 230 (29.8%) corresponded to the HR group (mean STS-PROM 11 [9.3-16.7]); 339 patients (44%) to the IR group (mean STS-PROM 6 [4.8-6.71]); and the remaining 201 (26.1%) were LR patients (mean STS-PROM 2.7 [2-3.24]). The proportion of low-risk patients considerably increased over the registry period (p trend 0.011). The femoral access was used in 95% of the cases and was percutaneous in 69%. Self-expanding valves were implanted in 80% of the patients. Twenty-three percent (n = 177) of the valves implanted corresponded to repositioning procedures without differences between groups. There were no differences in mortality at 30 days (HR 10.4%, IR 6.48%, LR 5.9%, p = 0.154). A reduction in mortality was observed in HR and LR patients (HR 13.7%-4.1%, p = 0.001; LR 11.7%-0%, p = 0.0023).

Conclusions: Risk stratification using surgical risk scores is still useful to guide therapeutic decisions; however, the indication of TAVI in the real world incorporates other factors not contemplated in the classical scoring system, which modify our decisions in daily practice.