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. 2024 Apr 15;16(4):e58334.
doi: 10.7759/cureus.58334. eCollection 2024 Apr.

Short-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement in a Developing Country

Nadia Chamoun  1 , Jennifer Jdaidani  1 , Dounia Z Iskandarani  1 , Sarah Ghalayini  1 , Ali Zgheib  1 , Alessandro Khoury  1 , Samir Alam  1 , Abdallah G Rebeiz  1 , Ziyad Ghazzal  1 , Fadi Sawaya  1
Affiliations

Short-Term Clinical Outcomes of Transcatheter Aortic Valve Replacement in a Developing Country

Nadia Chamoun et al. Cureus. .

Abstract

Introduction: Transcatheter aortic valve replacement (TAVR) is an effective alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis in all surgical risk groups. Reports of clinical outcomes post-TAVR in developing countries are scarce. We aimed to address the clinical outcomes and safety profile of TAVR in a developing country.

Methods: We conducted a single-center, retrospective study on patients undergoing TAVR at the American University of Beirut Medical Center (AUBMC) from January 2016 to April 2023. We included a total of 399 patients. Our primary endpoint was to assess the rate of TAVR in-hospital and 30-day mortality, neurologic events, and new permanent pacemaker implantation (PPI) in patients, stratified by the Society of Thoracic Surgeons (STS) risk of mortality score.

Results: Survival rates were 98.7% (394) at discharge vs. 97.5% (389) at 30 days post-procedure. The technical success rate was 95% (379) at the end of the procedure. Device success and early safety rates were 93.5% (373) and 83% (331), respectively at 30 days post-procedure. The all-cause mortality rate increased from 1.3% (5) at discharge to 2.5% (10) at 30-day intervals. The rate of ischemic stroke was 1.3% (five) at discharge and increased to 2% (eight) at 30 days post-procedure. PPI was needed in 5.8% (23) of patients at discharge with an increase to 7% (28) at one-month interval. Overall, the rates of TAVR outcomes among the three risk groups were comparable including neurologic events, valve-related complications, bleeding problems, vascular and access-related complications, and myocardial infarction.

Conclusion: This study at AUBMC highlights the successful implementation of the TAVR program in a developing country, showcasing its efficacy and safety within 30 days post-operation, despite challenges such as financial constraints and limited access to specialized training. Larger cohorts and longer follow-up periods are needed to accurately represent clinical outcomes in developing countries.

Keywords: aortic valve disease; clinical outcomes; developing country; morbidity and mortality; neurologic complications; pacemaker insertion; tavr; third world country; transcatheter aortic valve replacement.

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Conflict of interest statement

The authors have declared financial relationships, which are detailed in the next section.

Figures

Figure 1
Figure 1. Number of TAVR cases per year
TAVR: transcatheter aortic valve replacement
Figure 2
Figure 2. Bioprosthetic valves deployed during TAVR
TAVR: transcatheter aortic valve replacement
Figure 3
Figure 3. Proportion of new permanent pacemaker insertion stratified by the type of bioprosthetic valve used
PPI: permanent pacemaker insertion
See this image and copyright information in PMC

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