Impact of Updated Guidelines on TAVI Outcomes in a Health Maintenance Organization in Brazil: A Decade-Long Retrospective Study

Abstract

Background

Aortic stenosis is a progressive condition that leads to significant morbidity and mortality if untreated. Transcatheter aortic valve implantation (TAVI) provides a less invasive alternative to surgical aortic valve replacement (SAVR), particularly for high-risk patients.

Objectives

This study evaluates the outcomes of TAVI procedures performed in a Health Maintenance Organization (HMO) in Brazil from 2013 to 2023, focusing on the impact of clinical guidelines updated in 2018.

Methods

A retrospective cohort study included 325 patients diagnosed with severe symptomatic aortic stenosis who underwent TAVI. Patients were divided into two groups: those treated before January 2019 (n=56) and those treated from January 2019 onwards (n=269). The primary outcomes included all-cause mortality and major complications, while the secondary outcomes encompassed procedural success rates and specific complication rates. Continuous variables were analyzed using the Mann-Whitney test, and categorical variables were analyzed using the chi-square test or Fisher’s exact test. Statistical significance was defined as p < 0.05.

Results

After January 2019, the shift to self-expanding valves was associated with a statistically significant reduction in pacemaker implantation rates (from 28.6% to 18.2%, p=0.03), whereas other outcomes did not reach statistical significance.

Conclusions

The implementation of updated protocols was associated with improved TAVI outcomes, especially a reduced need for pacemaker implantation, supporting its expanded use in intermediate-risk patients.