Patient Pathways and Outcomes Following Referral to a Dedicated Clinic for TAVI Program: Insights from the Egyptian National Heart Institute

Background The most common valvular heart disease in elderly populations and with a dismal prognosis in the case of its development is degenerative aortic stenosis. The use of transcatheter aortic valve implantation (TAVI) has transformed the treatment of the entire surgical risk spectrum, but there is limited real-world data that define the patterns of treatment and post-treatment results in the Middle East and North Africa (MENA) region. Objectives To characterize the pattern of treatment allocation, clinical and procedural outcome, and predictors at the baselines of six months mortality in patients in a row who were referred to a specialist assessment of severe symptomatic aortic stenosis at a dedicated structural heart clinic in Egypt. Methods The study was performed as a retrospective examination using a single-center registry at the National Heart Institute, Cairo, Egypt among consecutive patients who were referred to the institute between January 2024 and December 2025. A multidisciplinary Heart Team offered patients TAVI, surgical aortic valve replacement (SAVR), or optimum medical therapy (OMT). The GOTHI Ethical Approval Committee (IHC00154) approved the study as ethical. Kaplan-Meier analysis was done to perform survival analysis. Firth-penalized Cox proportional hazards regression was used to examine the exploratory predictors of six-month mortality. Results Of 258 patients screened, 201 met inclusion criteria. Treatment allocation was: TAVI (n=131, 65.2%), SAVR (n=28, 13.9%), and OMT (n=42, 20.9%). TAVI recipients were older (median 82 years) with higher surgical risk scores than SAVR patients (median 71 years, STS-PROM 1.9% vs. 4.5%; descriptive comparison only). Six-month all-cause mortality was 9.2% (95% CI 4.8–15.6) for TAVI, 17.9% (95% CI 6.1–36.9) for SAVR, and 16.7% (95% CI 7.0–30.8) for OMT; twenty-four deaths occurred in total. These figures are unadjusted and subject to profound confounding by indication — owing to the absence of validated frailty assessment, no causal treatment comparison can be drawn. TAVI procedural success was 96.9%; new permanent pacemaker implantation occurred in 20.0% of eligible patients. In an exploratory Firth-penalised multivariable model (events-per-variable ratio=12.0), STS-PROM score and TAVI treatment allocation were associated with six-month mortality; these associations require validation. Conclusions In this real-world registry from an Egyptian tertiary center, TAVI was the most frequently selected treatment strategy for severe symptomatic aortic stenosis. Approximately one-fifth of evaluated patients received conservative management, reflecting the clinical complexity of elderly, comorbid referral population. All mortality comparisons between treatment groups are descriptive and hypothesis-generating only; the absence of validated frailty assessment precludes any causal inference. Larger, prospective, multi-center studies with comprehensive frailty characterization are required to define treatment outcomes in this under-represented region.