Long-term clinical outcomes of TAVI in hospitals without on-site cardiac surgery: insights from the MURGIA-TAVI Registry.

AIMS: Transcatheter aortic valve implantation (TAVI) is the standard of care for elderly (≥70 years) or high-risk patients with severe aortic stenosis, yet current guidelines recommend its performance only in Heart Valve Centres with on-site cardiac surgery. This study evaluated procedural safety and long-term outcomes of TAVI performed in selected non-surgical centres. METHODS: We retrospectively analysed 186 consecutive patients undergoing TAVI at 'F. Miulli' Hospital between 2016 and 2024, enrolled in the MURGIA-TAVI Registry. The programme operated without institutional on-site cardiac surgery, supported by a structured Heart Team approach and a visiting surgical back-up. Outcomes were assessed according to Valve Academic Research Consortium-3 definitions and survival was evaluated up to 5 years. RESULTS: Among 186 patients (mean age 82 years; STS score 7%), transfemoral access was used in 93%. Technical success was 98.9%, with no intraprocedural deaths. Conversion to emergent cardiac surgery occurred in two patients (1.1%); both survived at 30 days. In-hospital mortality was 1.6%, never valve-related. Major complications included cardiac tamponade (1.6%), major bleeding (2.2%) and major vascular complications (1.1%). At 1 year, mortality was 15.6% with no valve-related deaths, and valve dysfunction occurred in 1.9% of patients. Five-year survival reached 52.5%. Outcomes, including rates of emergent cardiac surgery, were comparable to those reported in published registries from centres without institutional on-site cardiac surgery. CONCLUSIONS: Our findings suggest that TAVI can be safely performed in selected hospitals without on-site cardiac surgery within a structured Heart Team framework and a visiting surgical back-up, potentially expanding access, shortening waiting times, and meeting the growing demand for TAVI.