TAVI in hospitals without cardiothoracic surgical support in Finland between 2015 and 2018

BackgroundFrom 2018, the TAVI procedure (transcatheter aortic valve implantation) was prohibited in hospitals without cardiothoracic surgical support in Finland. Before the regulation entered into force, TAVI operations were performed in four central hospitals.

MethodsIn 2015–2018, the TAVI procedure was performed in 174 patients with the same self-expanding valve type (EvolutR, Medtronic). Except for one, all procedures were performed under local anaesthesia via the femoral artery in the catheterization laboratory using the minimalist approach. 

ResultsThe average age of patients was 83 years. Before the procedure, patients were very symptomatic: 80% had NYHA ≥ 3 symptoms. The mean Euroscore II and STS scores were 4.1% and 3.7%, respectively. Three (1.7%) patients had vascular complications that required surgery. Two patients died during the procedure (1.1%). Five (2.9%) patients had died within 30 days and nine (5.2%) within 12 months. In the follow up, 84% of patients experienced symptom relief. Ninety-seven percent of patients had no moderate or severe paravalvular regurgitation in the follow up and the mean valvular gradient was 8 mmHg. 

ConclusionsTAVI procedures carried out in central hospitals without cardiothoracic surgical support were safe and effective and the results comparable to previously reported randomised trials. 

Tuomas Rissanen, Iina Repo, Tomi Kaukonen, Jarkko Niva, Kai Nyman, Tuomas Paana, Tuomas Varis, Pasi Karjalainen

Tuomas T. Rissanen

M.D., Ph.D., Associate Professor, Head of Cardiology

Heart Center, Central Hospital of North Karelia