[Accessibility to TAVI in a center without cardiac surgery : a Corsican example]

Aortic stenosis is the most common valvular disease in France. Its prevalence increases with age, affecting more than 10 % of people over 70 years old. Once symptomatic, the prognosis is grim, with a mortality rate close to 50 % within 2 years. European guidelines for the management of severe aortic stenosis recommend rapid treatment upon the onset of symptoms. However, aortic stenosis remains largely underdiagnosed and undertreated, especially with limited and increasingly complex access to care due to geography. The primary objective of this work is to analyze the management of all patients with symptomatic severe aortic stenosis referred to the Bastia Hospital from January 2019 to December 2022. The secondary objective is to study the factors that delay care and assess the consequences for these patients' outcomes.

Data from 151 patients diagnosed with symptomatic severe aortic stenosis between January 1, 2019, and December 31, 2022, at the Bastia Hospital were retrospectively collected.

Our population consisted of 69 % men, with an average age of 80 years. The operative risk was low, with an average Euroscore of 5 (Euroscore 0-45). The vast majority of patients were symptomatic, with exertional dyspnea NYHA >2 (76 %). The average LVEF was 55 %, meaning most patients had preserved left ventricular ejection fraction. One significant piece of data we collected was the waiting time before the procedure. Among the included patients (102), the time between diagnosis and TAVI implantation was an average of 162 days (over 5 months). The time between coronary angiography and TAVI implantation was around 109 days, compared to the national average of 70 days. Among the included patients, 13 % died while on the waiting list, and 7 % refused the proposed treatment. The study of preoperative workup delays did not identify any particular test as the main cause, but we can conclude that the overall process contributes to these results.

This study reveals that a quarter of patients with severe aortic stenosis in this population currently cannot benefit from percutaneous valve replacement. On-site management, without the need for cardiac surgery, could be considered to reduce waiting times and mortality, as is done elsewhere in Europe.