Registry of Transcatheter Aortic Valve Implantation (TAVI) for Patients with Severe Aortic Stenosis at Ain Shams University Hospitals

Abstract

Abstract Background TAVI is now the standard of care for inoperable patients and a valid alternative to surgery for many high-risk patients (5). it has shown non-inferiority to SAVR in patients with intermediate risk for cardiac surgery, Other recent trials have assessed the safety of TAVI in low-risk patients such as the PARTNER 3, Nordic NOTION 2 and the Medtronic TAVR low risk trial. Aim The aim of this study was to evaluate the clinical and echocardiographic outcomes in patients undergoing successful TAVI at Ain Shams University Hospitals during six months follow-up after the procedure, according to the Valve Academic Research Consortium-3 (VARC-3). (9) Methods This is a retrospective & prospective cohort Study. It was conducted in cardiology department, Ain Shams University Hospitals in the period of November 2022 to May 2023.it included (151) patients who were treated with TAVI in Ain Shams University Hospitals in the period From January 2020 to October 2022 retrospectively and from November 2022 to May 2023 prospectively29 patients were missed during follow up and excluded due to incomplete data and failure of follow up, to end the study with (122) patients, fulfilling the inclusion criteria. Results Regarding death as the most objective and unbiased endpoint, our registry reported a 30-day survival rate of (97.5%), and a six-month survival rate of (96.7%). Regarding symptomatology, our registry shows high significant improvement of symptoms with 99 (81.1%) of patients were asymptomatic at follow up, p-value (<0.001), and the majority of patients with NYHA III (73%) & IV (26.2%) at baseline show high significant improvement with majority of patients at NYHA I (91.8%) & II (7.4%) at follow up with p-value (<0.001). Based on echocardiography assessment in our registry, TAVI significantly improved the patient’s hemodynamics. The mean pre- and post-procedural left ventricular ejection fraction were 59.10 ± 14.62 and 62.70 ± 11.75 respectively with p-value (<0.001), also patients with reduced EF% show significant improvement with mean pre- and post-procedural LV EF% 33.44 ± 8.42 and 42.16 ± 8.40 respectively with p-value (<0.001), The mean pre- and post-procedural pressure gradient (MPG) was 50.12 ± 14.00 and 6.13 ± 1.58 respectively with p-value (<0.001), with more than (99%) absence of moderate or severe valvular leak. Conclusions Our registry shows favourable short-term clinical outcomes in unselected TAVI patients, The study found that TAVi candidates in Egypt were younger, had a lower risk for cardiac surgery, and had lower rates of post-procedural complications and mortality than other international all-comer registries, denoting the procedure as safe and beneficial especially by accumulating experience and technical advances in devices and not only add years to patients life by reducing all-cause mortality but also add life to their years by improving quality of life.