Background. Current evidence on TAVI has been generated exclusively by cardiology studies and no operative data from cardiac surgeons are available. Here we describe the development of our TAVI program and report the results of transfemoral TAVI done by cardiac surgeons on their own.
Methods. The “surgical” TAVI program was built from the ground up in October 2018. Relevant prospectively collected preoperative, intraprocedural and postoperative data were retrieved from the Institutional database. A multivariable logistic regression was used to study the association of preoperative clinical characteristics, the progression of the experience and the operators, with postoperative early outcomes.
Results. A total of 502 patients were included in the study. Mean patients’ age was 82 years and STS score was 3.1% (2.2 – 4.4). Eighty-five patients underwent transapical TAVI and 417 patients had a transfemoral approach. We progressively moved from TA TAVI towards TF procedures now routinely performed on conscious sedation and using a fully percutaneous approach (Figures 1-3). Both balloon expandable (60.3%) and self-expandable valves (39.6%) were used. After TF TAVI technical success (according to VARC 3 criteria) was achieved in 99.1% of cases. Thirty-day mortality rate was 1%, stroke occurred in 2% of the cases and permanent pacemaker implantation was necessary in 23% of the patients. A moderate or severe paravalvular leak was observed in 4.4% and 0.7% of patients, respectively
Conclusions. The acquisition of catheter-based skills and an adequate training allowed cardiac surgeons to perform on their own awake and fully percutaneous TF TAVI with excellent early results.