Clinical outcomes with transcatheter aortic valve implantation at a single cardiac center in Saudi Arabia

BACKGROUND: Transcatheter aortic valve implantation (TAVI) has been recognized as a valid alternative to surgery for severe aortic valve stenosis (AS) in high-risk surgical patients. OBJECTIVE: Determine first-year clinical outcomes for TAVI at Madinah Cardiac Center (MMC) in Saudi Arabia. DESIGN: Retrospective, analytical cross-sectional. SETTING: Tertiary cardiac care center. PATIENTS AND METHODS: All patients who underwent TAVI for severe AS between February 2013 and December 2016 were included. Clinical, imaging, and laboratory information at baseline and at one year follow-up were analyzed. MAIN OUTCOME MEASURES: Clinical and echocardiography outcomes at discharge, at 1-month, and at end of follow-up; one-year mortality, complications and clinical response to TAVI procedure. SAMPLE SIZE AND CHARACTERISTICS: N=80, mean (SD) age 79.5 (10.6) years, with severe AS and high-surgical risk. RESULTS: Fifty-five (69.2%) patients received Core valves, and 25 (30.8%) received Edward valves. Peri-procedure mortality was 3.8% and 1-year post-operative mortality was 13.8%. Ten patients (12.5%) had life-threatening or major bleeding. Nineteen (23.8%) patients had vascular complications, which were mostly minor. Fourteen patients (17.5%) developed acute kidney injury and 86% of these patients recovered. Five patients (6.25%) had pericardial effusion. Two patients (2.5%) developed endocarditis and another 2 patients (2.5%) had cerebrovascular accidents. Five patients (6.25%) received pacemakers. Mean aortic valve gradient significantly reduced from a mean (SD) 47.6 (19) mm Hg to 10.7 (6.0) mm Hg (P<.001). New York Heart Association functional class was significantly reduced (P<.001). CONCLUSION: The TAVI experience at MCC is encouraging and comparable to international outcomes in terms of success, morbidity, and mortality rate. LIMITATIONS: Retrospective, relatively small sample size. Rate of minor bleeding was overestimated.