The role of learning curve on the results of aortic valve implantation for severe aortic stenosis

Czech version

Authors: Petr Kala ¹; Petr Němec ^2,3; Petr Malík ²; Jiří Ondrášek ²; Martin Třetina ²; Petr Pokorný ²; Jiří Jarkovský ⁴; Milan Bláha ⁴
Authors‘ workplace: Interní kardiologická klinika LF MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC ¹; Centrum kardiovaskulární a transplantační chirurgie Brno, ředitel doc. MUDr. Petr Němec, CSc. ²; Mezinárodní centrum klinického výzkumu FN u sv. Anny – ICRC Brno, ředitel Gorazd B. Stonkin, M. D., MSc., Ph. D. ³; Institut biostatistiky a analýz LF MU Brno, ředitel doc. RNDr. Ladislav Dušek Ph. D. ⁴
Published in: Vnitř Lék 2014; 60(4): 316-321
Category: 60th Birthday - prof. MUDr. Petr Widimský, DrSc., FESC, FACC

Overview

Introduction:
Patients with serious aortic stenoses treated by conservative therapy have significantly worse life expectancy. Besides the surgical aortic valve replacement (AVR) as the gold standard of therapy, the transcatheter aortic valve implantation (TAVI) is indicated in patients at very high risk or who are contraindicated to AVR. The role of learning-curve in TAVI has to be established.

Aim:
Assessment of the results of consecutive TAVI procedures based on the experience of the team. Methods: 58 high-risk consecutive patients with the average age of 82.2 years were divided into 3 groups based on the TAVI order (≤ 20., 21.–40., 41.–58.). After the Edwards SAPIEN implantation via transfemoral or transapical approaches, all patients were followed for minimum 30 days. Data from the national registry (Czech TAVI Registry) were used for the retrospective analysis. Comparison of the groups was done by using the Kruskal-Wallis test, Mann-Whitney U test and χ2 test.

Results:
Significantly shorter procedural time (p < 0.001), hospitalization (p = 0.033) and a lower amount of contrast medium (p < 0.001) was observed during the time. There was no difference in the rate of clinical complications at 30 days.

Conclusions:
Increasing experience of the TAVI implantation team is associated with significantly shorter procedural time, hospitalization and a lower amount of contrast medium. Overall very good clinical results during 30 days were not affected by the team experience.

Key words:
aortic stenosis – aortic valve implantation – TAVI – learning curve

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