Related Experiment Video
Updated: Sep 17, 2026
Upper-extremity Approach for Secondary Access in Transfemoral Transcatheter Aortic Valve Implantation
Published on: August 8, 2025
Transcatheter aortic valve implantation without immediate cardiac surgery backup. A single-center retrospective
António Rocha de Almeida1,2, Renato Fernandes1,2, Ângela Bento1,2
1Departamento de Cardiologia, Hospital Espírito Santo de Évora, Unidade Local de Saúde Alentejo Central, Évora, Portugal.
Introduction And Objectives:
Transcatheter aortic valve implantation (TAVI) is traditionally performed with on-site cardiac surgery (CS) backup. However, procedural advances enabled TAVI to be performed safely without immediate CS backup. This study describes our single-center experience with TAVI performed in a center without on-site CS backup.
Methods:
We conducted a retrospective analysis of the first 300 patients undergoing TAVI without on-site CS backup between 2020 and 2024. The primary endpoint was 30-day mortality. Secondary endpoints included procedural and in-hospital mortality, stroke, emergency cardiac surgery (ECS), vascular complications, major hemorrhage, and pacemaker implantation. Outcomes were compared with those from the Portuguese national TAVI registry.
Results:
The cohort mean age was 82±5 years (54% women). The median STS risk score was 3.8 [IQR, 2.3-6.6], with 17% high-risk patients (STS > 8). Most procedures were elective (83%). Transfemoral access was used in 99% of cases, and self-expandable valves were implanted in 95%. The 30-day mortality rate was 3.7% (n = 11), while stroke occurred in 2.7% (n = 8). The procedural survival rate was 99% (n = 298). No cases of ECS occurred (n = 0), coronary obstruction, TAVI-in-TAVI deployment as a bailout, or valve embolization were reported. Pericardial tamponade occurred in 0.7% of cases (n = 2). Major hemorrhage and vascular complications occurred in 8%, and pacemaker implantation in 20%. The 1-year mortality rate was 12%, with 4% attributed to cardiovascular causes; among survivors, and 91% reported symptomatic improvement. There were no significant differences in outcomes vs the results from the TAVI national registry.
Conclusions:
TAVI was safely and effectively performed without on-site CS, including emergency and complex cases. The non-ECS rate and outcomes comparable to national benchmarks support the feasibility of TAVI in selected non-CS centers. In this context, expanding TAVI access may reduce waiting times and improve the management of severe aortic stenosis while maintaining high procedural quality.