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

Abstract

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.

The Influence of the Learning Curve on Clinical Outcomes in Balloon-Expandable versus Self-Expandable Transfemoral Transcatheter Aortic Valve Implantation

“…The occurrence of more than mild paravalvular aortic regurgitation (AR) was also associated with the use of SE prostheses [6,7], but also with an increased long-term mortality risk [8][9][10][11]. While BE devices were associated with lower pacemaker implantation rates [3,12], SE devices proved to have better hemodynamic results due to a larger aortic orifice area [3,13].…”