329 Patient selection and learning curve influence the results of transapical aortic valve implantation

BackgroundTranscatheter aortic-valve implantation (TAVI) has become an essential alternative to surgical aortic-valve replacement in the treatment of symptomatic severe aortic stenosis, and this procedure requires technical expertise. The aim of this study was to identify prospective studies on TAVI from the past 10 years, and then to analyze the quality of information reported about the learning curve.Materials and methodsA systematic review of articles published between 2007 and 2017 was performed using PubMed and the EMBASE database. Prospective studies regarding TAVI were included. The quality of information reported about the learning curve was evaluated using the following criteria: mention of the learning curve, the description of a roll-in phase, the involvement of a proctor, and the number of patients suggested to maintain skills.ResultsA total of sixty-eight studies met the selection criteria and were suitable for analysis. The learning curve was addressed in approximately half of the articles (n = 37, 54 percent). However, the roll-in period was mentioned by only eight studies (12 percent) and with very few details. Furthermore, a proctorship was disclosed in three articles (4 percent) whereas twenty-five studies (37 percent) included authors that were proctors for manufacturers of TAVI.ConclusionMany prospective studies on TAVI over the past 10 years mention learning curves as a core component of successful TAVI procedures. However, the quality of information reported about the learning curve is relatively poor, and uniform guidance on how to properly assess the learning curve is still missing.

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The SOURCE Registry: what is the learning curve in trans-apical aortic valve implantation?

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2010.11.018 ◽

2011 ◽

Vol 39 (6) ◽

pp. 853-860 ◽

Cited By ~ 45

Author(s):

Olaf Wendler ◽

Thomas Walther ◽

Holger Schroefel ◽

Rüdiger Lange ◽

Hendrik Treede ◽

...

Keyword(s):

Aortic Valve ◽

Learning Curve ◽

In Trans ◽

Aortic Valve Implantation ◽

Valve Implantation

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Patient selection for minimally invasive aortic valve implantation

European Journal of Cardio-Thoracic Surgery ◽

10.1016/j.ejcts.2007.03.036 ◽

2007 ◽

Vol 32 (1) ◽

pp. 188-188

Author(s):

Dimitri Kalavrouziotis ◽

Karen J. Buth ◽

Jean-Francois Legare

Keyword(s):

Aortic Valve ◽

Minimally Invasive ◽

Patient Selection ◽

Aortic Valve Implantation ◽

Selection For ◽

Valve Implantation

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Transaortic Transcatheter Aortic Valve Implantation: Learning Curve, Perioperative, and Midterm Follow-Up Results of a Single Center

The Heart Surgery Forum ◽

10.1532/hsf.2249 ◽

2019 ◽

Vol 22 (2) ◽

pp. E134-E139 ◽

Cited By ~ 1

Author(s):

Giuseppe D’Ancona ◽

Huesyin Ince ◽

Christoph Raspé ◽

Alper Öner ◽

Evren Caglayan ◽

...

Keyword(s):

Aortic Valve ◽

Learning Curve ◽

Contrast Agent ◽

Transcatheter Aortic Valve Implantation ◽

Aortic Insufficiency ◽

Transcatheter Aortic Valve ◽

Institutional Experience ◽

Aortic Valve Implantation ◽

Valve Implantation

Background: We present our initial institutional experience with transaortic (TAo) transcatheter aortic valve implantation (TAVI) using a self-expanding aortic bioprosthesis. Methods: A total of 106 patients underwent TAo TAVI with Medtronic CoreValve through a small partial upper sternotomy. We focus our analysis on the overall perioperative results, procedural learning curve (first 30 patients), and midterm follow-up outcomes. Results: VARC-2 device success was achieved in 95 patients (89%), and there were no intraoperative deaths. Nine patients (8.4%) required a second valve and conversion to standard surgery was required in 2 patients (1.8%). The final aortic insufficiency was grade 0 in 65 patients (62%) and grade 1 in 39 (37%). Although patients treated in the TAo TAVI learning phase required a significantly longer radiation time and contrast agent use, device success (93.4% versus 88.2%; P = .7) and prostheses hemodynamics were similar. All-cause mortality at 30 days was 12% (13/106). At a median follow-up of 392 days (IQR: 216-494 days) estimated overall 1-year survival was 72%. No significant differences were reported in terms of 30-day and 1-year observed mortality, and estimated 1-year survival in the learning and later phase of TAo TAVI. Conclusion: TAo TAVI can be performed safely even in the very early phase of the learning curve. Although satisfactory results can be achieved from the beginning, a significant reduction in contrast agent use and radiological exposure are expected as the technique is mastered. Good hemodynamics have been documented and should be further improved with modifications achieved in the TAVI self-expandable valves technology.

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Alternate Access for TAVI: Stay Clear of the Chest

Interventional Cardiology Review ◽

10.15420/icr.2018.22.1 ◽

2018 ◽

Vol 13 (3) ◽

pp. 145 ◽

Cited By ~ 13

Author(s):

Pavel Overtchouk ◽

Thomas Modine ◽

◽

Keyword(s):

Aortic Valve ◽

Learning Curve ◽

Transcatheter Aortic Valve Implantation ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Poor Outcomes ◽

Valve Implantation ◽

Transapical Access ◽

Experimental Stage ◽

Existing Data

Transcatheter aortic valve implantation (TAVI) is currently performed through an alternative access in 15 % of patients. The transapical access is progressively being abandoned as a result of its invasiveness and poor outcomes. Existing data does not allow TAVI operators to favour one access over another — between transcarotid, trans-subclavian and transaortic — because all have specific strengths and weaknesses. The percutaneous trans-subclavian access might become the main surgery-free alternative access, although further research is needed regarding its safety. Moreover, the difficult learning curve might compromise its adoption. The transcaval access is at an experimental stage and requires the development of dedicated cavo-aortic crossing techniques and closure devices.

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