INTRODUCTION:

Transcatheter aortic valve implantation (TAVI) is the best therapeutic option for most patients with severe symptomatic aortic stenosis, but the development of TAVI programs in LATAM has been slow and uneven, mainly due to the lack of economic coverage. Recently, in 2023, our country has incorporated coverage of the procedure through the National Resource Fund for patients with moderate and high surgical risk (STS >4%). The STS score and the EuroSCORE II are the worldwide preferred methods (over the EuroSCORE I) for estimating surgical aortic valve replacement (SAVR) risk and as screening tool for patients being considered for TAVI. Recently, the STS observed-to-expected 30 day mortality ratio has been proposed as the gold standard method to analyze SAVR 30 day results. However, in our country, SAVR results are evaluated using the EuroSCORE I observed-to-expected 30 day mortality ratio because the observed surgical mortality rates correlate with that predicted by EuroSCORE I.

OBJECTIVES:

To present the 30-day results and analyze the observed-to-expected 30 day mortality ratio of our TAVI program in two tertiary centers in Uruguay with the start of coverage by the National Resource Fund in 2023.

METHODS:

All consecutive patients undergoing transfemoral TAVI in 2023 at two tertiary centers in our country were included in our TAVI registry and analyzed retrospectively. The analysis of results was carried out using the VARC-3 criteria. The STS, EuroSCORE II and EuroSCORE I 30 day mortality risk were calculated for all patients using the online risk calculator for SAVR. The observed 30-day mortality was divided by the average expected mortality based on the SAVR risk scores to obtain the observed-to-expected ratios.

RESULTS:

From January 2023 to December 2023, 117 patients with symptomatic severe aortic stenosis were treated by transfemoral TAVI by our group. The mean age was 82.7±6.0 years and 58.1% were women (n=68). The logistic EuroSCORE I was 24.7±12.2%, the EuroSCORE II was 5.0±3.6% and the STS was 4.4±2.1%. In-hospital mortality was 0.9% (n=1). The observed mortality was lower than the expected mortality estimated by the EuroSCORE I (p<0.0001) and no significantly lower than the expected mortality estimated by the EuroSCORE II (p=0.12) and by the STS (p= 0.21). All observed-to-expected ratios were less than 1 (0.04 using the EuroSCORE I, 0.18 using the EuroSCORE II and 0.20 using the STS) suggesting a survival advantage conferred by the TAVI procedure.

CONCLUSIONS:

The immediate clinical results after TAVI at two tertiary centers in our country are similar to those obtained in randomized studies and international registries. The observed-to-expected ratio was 0.20 for the STS, 0.18 for the EuroSCORE II and 0.04 for the logistic EuroSCORE I suggesting a survival benefit for TAVR at 30 days when compared with expected SAVR mortality.