REVIEW   

Minerva Cardiology and Angiology 2024 April;72(2):204-11

DOI: 10.23736/S2724-5683.22.06076-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Transcatheter aortic valve intervention in hospitals without cardiac surgery departments: a future scenario?

Stefano RIGATTIERI ¹ ✉, Chiara BERNELLI ², Francesco TOMASSINI ³, Giorgio CARETTA ⁴, Shahram MOSHIRI ², Andrea BERNI ¹, Ferdinando VARBELLA ³, Alberto MENOZZI ⁴

¹ Interventional Cardiology Unit, Sant’Andrea University Hospital, Rome, Italy; ² Department of Cardiology, Santa Corona Hospital, Pietra Ligure, Savona, Italy; ³ Interventional Cardiology Unit, Ospedale degli Infermi, Rivoli, Turin, Italy; ⁴ Section of Cardiology, Sant’Andrea Hospital, ASL 5, La Spezia, Italy

Transcatheter aortic valve intervention (TAVI) was introduced in early 2000 to offer treatment to inoperable patients with severe aortic valve stenosis. In a couple of decades, the procedure resulted effective and safe also in patients with intermediate to low risk for surgery; therefore, due to the progressive ageing of the population, the clinical need for TAVI is continuously increasing and is hardly met by the availability of the procedure, the so-called “TAVI capacity”. As a result, many patients encounter difficulties in being referred to TAVI centers or face long waiting list times, thus risking severe adverse events (including death) before the procedure is performed. Although contemporary guidelines and consensus documents recommend that TAVI should only be performed in hospitals with active cardiac surgery departments, starting TAVI programs also in interventional cardiac laboratories without on-site cardiac surgery could represent a way to increase TAVI capacity, thus leading to a greater number of patients being treated in less time. On the other side of the coin, such a strategy may jeopardize patient safety in case of periprocedural complications needing bailout surgery and may lead to a suboptimal multidisciplinary Heart Team evaluation. This review aims to assess and discuss available clinical data and implementation of TAVI programs in hospitals without on-site active cardiac surgery departments considering the growing unmet clinical need and technical advancement of TAVI platforms, yet not overlooking the recommendations of international scientific societies.

KEY WORDS: Aortic valve stenosis; Cardiac surgical procedures; Cardiac catheterization