Abstract 4365826: Tackling Socioeconomic Disparities in Access to TAVR in Low-Resource Settings: A Humanitarian Mission in the Dominican Republic

Background: Aortic stenosis remains a significant cause of morbidity and mortality worldwide. Transcatheter aortic valve replacement (TAVR) has become a transformative therapy for patients with severe aortic stenosis who are not suitable candidates for traditional surgical valve replacement in developed countries. However, access to TAVR therapy is highly variable, particularly in developing countries where resources and infrastructure may be limited. Objective: This study aims to elucidate the existing disparities in access to TAVR therapy in developing nations and propose sustainable strategies. We report over a decade of experience and outcomes from performing TAVR during humanitarian missions in a resource-limited setting of a developing country. Methods: This is a case series conducted on patients who underwent TAVR in Santo Domingo, Dominican Republic, between June 2010 and May 2024. Eligibility criteria included symptomatic severe aortic stenosis deemed high-risk or inoperable for surgical valve replacement in patients of limited economic resources. Baseline clinical characteristics and main outcomes, such as intra- and post-procedural complications, as well as the 30-day mortality rate, were obtained. Results: A total of 18 patients were included, with a mean age of 76 years (SD ± 5), predominantly female (56%). High rates of hypertension (88.9%), diabetes mellitus (44.4%), and heart failure (16.7%) were observed. Balloon-expandable valves were implanted in 56% of cases, while the remaining 44% received self-expandable valves. Two patients had complications during the procedure, including left ventricular perforation leading to cardiac tamponade and aortic annular rupture in another patient. Both patients expired intra-op or within 24 hours post-op. One patient developed complete heart block requiring permanent pacemaker placement. Self-resolving groin hematoma was seen on one occasion. None of the patients required re-intervention. There were no significant paravalvular leaks post valve implantation. The mortality rate at 30-day follow-up was 11%. Conclusion: Disparities in access to TAVR persist in developing countries, disproportionately affecting individuals of lower socioeconomic status. Strategies targeting the equitable distribution of healthcare resources and financial assistance programs are warranted. This humanitarian experience demonstrates the viability of performing TAVR as part of humanitarian medical missions to developing countries.