CONGRESS ABSTRACT

Background: The number of patients with severe aortic stenosis eligible for transcatheter aortic valve implantation (TAVI) has increased worldwide. To shorten waiting times, ensure equal access to care for all referred patients, and strengthen collaboration with spoke centers, we implemented a dedicated Hub & Spoke model in our regional TAVI pathway. Methods: According to our protocol, the initial clinical evaluation—including echocardiography, computed tomography and coronary angiography—was performed at the spoke center, where patients were also followed in a dedicated TAVI clinic. Each case was discussed by a multidisciplinary Heart Team, including cardiac surgeons of the Hub and the interventional cardiologist of the Spoke. Patients were admitted to the Spoke center, transferred to the Hub center for TAVI, and returned to the Spoke center after 12–24 hours of post-procedural monitoring, if no complications occurred. The spoke center operator completed a master’s degree in structural cardiology and subsequently completed a finalized training appointment at a high-volume center in a different region prior to.program initiation.After this phase, procedures were performed by the Spoke center interventional cardiologist in collaboration with a cardiac surgeon from the Hub center as second operator Results: Between July 2021 and November 2025, 60 patients with severe aortic stenosis underwent TAVI (mean age 82 years; 60% female; mean left ventricular ejection fraction 58.0 ± 9.7%). A balloon-expandable valve (Edwards Sapien 3 Ultra) was implanted in 65% of cases. A transfemoral approach was used in 95% of patients. Five patients required prolonged hospitalization at the hub center: three due to transapical access, one because of vascular complications requiring surgery and one following intra-procedural cardiac arrest resulting in death. At 30 days no deaths were observed. The pacemaker implantation rate was required in five patients. Conclusions: The Hub & Spoke TAVI model proved to be safe and effective, leading to reduced waiting lists, optimized bed utilization, equitable access to treatment, with no significant implementation of resources. Additionally, it promoted increased awareness, education, and training among healthcare operators in spoke centers.