The effect of the learning curve on paravalvular aortic regurgitation and mid‐term mortality in transfemoral transcatheter aortic valve implantation

Objective Paravalvular aortic regurgitation is an important independent mortality predictor in transcatheter aortic valve implantation (TAVI). Our study evaluated the association between paravalvular aortic regurgitation and mid‐term mortality in relation with the learning curve, in patients with se...

Full description

Saved in:

Bibliographic Details
Published in:	Echocardiography (Mount Kisco, N.Y.) Vol. 39; no. 2; pp. 204 - 214
Main Authors:	Istrate, Mihnea, Dregoesc, Mihaela I., Bolboacă, Sorana D., Botiș, Cătălin, Ștef, Adrian, Bindea, Dan I., Oprea, Alexandru, Trifan, Cătălin A., Moț, Ștefan D. C., Molnar, Adrian, Iancu, Adrian C.
Format:	Journal Article
Language:	English
Published:	United States 01-02-2022
Subjects:	aortic stenosis Aortic Valve - diagnostic imaging Aortic Valve - surgery Aortic Valve Insufficiency - etiology Aortic Valve Stenosis - complications Aortic Valve Stenosis - surgery Heart Valve Prosthesis - adverse effects Heart Valve Prosthesis Implantation - methods Humans Learning Curve Male paravalvular aortic regurgitation transcatheter aortic valve implantation Transcatheter Aortic Valve Replacement - methods Treatment Outcome transcatheter aortic valve implantation aortic stenosis paravalvular aortic regurgitation learning curve
Online Access:	Get full text
Tags:	Add Tag No Tags, Be the first to tag this record!

Description
Summary:	Objective Paravalvular aortic regurgitation is an important independent mortality predictor in transcatheter aortic valve implantation (TAVI). Our study evaluated the association between paravalvular aortic regurgitation and mid‐term mortality in relation with the learning curve, in patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program. Methods Patients with severe aortic stenosis who underwent transfemoral TAVI between 2017 and 2020 were included in the analysis. Paravalvular aortic regurgitation was assessed by transthoracic echocardiography at 48 hours after the procedure. All‐cause mortality was evaluated after 30 days and at mid‐term follow‐up. Results Paravalvular aortic regurgitation ≥grade II was associated with mid‐term all‐cause mortality (OR 4.4; 95%CI 1.82–11.55; p < 0.001), their prevalence declining after the first 60 cases. Baseline characteristics did not significantly differ in the first 60 patients from the rest of the cohort. Male sex (p = 0.006), advanced age (p = 0.04), coronary artery disease (p = 0.003), or elevated STS Score (p = 0.02) influenced mid‐term survival. When adjusting for the presence of these factors, only age (OR 1.1; 95%CI 1.0–1.2), paravalvular aortic regurgitation ≥grade II (OR 3.9; 95%CI 1.3–12.9), and the number of days spent in the intensive care unit (OR 1.4; 95%CI 1.1–1.8) were independent predictors of mid‐term all‐cause mortality. Conclusions In a group of patients with severe aortic stenosis who underwent transfemoral TAVI in the first 3 years since the establishment of the program, paravalvular aortic regurgitation ≥grade II was associated with mid‐term mortality, both declining after the first 60 cases.
Bibliography:	Mihnea Istrate and Mihaela I. Dregoesc contributed equally to this work. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0742-2822 1540-8175
DOI:	10.1111/echo.15289