Impact of procedural volume on outcome optimization in transaortic transcatheter aortic valve implantation

An adequate procedural volume seems to be required to minimize the complication rate in TAVI. However, very few studies have investigated the relationship between procedural volume and outcomes in TAVI especially via the transaortic approach. The aim of this study was to evaluate the effect of procedural volume on the outcomes of transaortic TAVI (TAo-TAVI).

257 consecutive TAo-TAVI cases performed by 2 cardiac surgeons between January 2011 and June 2014 were included in the current analysis. Cumulative sum (CUSUM) failure analysis of combined 30-day safety endpoints was used in order to evaluate the learning curves. We divided the cases into two groups: early experience and late experience, respectively. Procedure and outcome variables were compared.

The CUSUM analysis revealed a learning curve regarding the occurrence of adverse events at 30days with an improvement after the initial 128 cases. We divided the cases into two groups (early group: cases 1 to 128; late group: cases 129 to 257). Although the rate of 30-day mortality was not significantly different between the 2 groups (11% and 7%, p=0.268), the incidence of adverse events such as life-threatening bleeding, stroke and AKI was significantly decreased in the late phase group (9% and 1%, p=0.002; 5% and 0%, p=0.014; 16% and 6%, p=0.002, respectively).

The incidence of adverse events was significantly decreased in the late phase group. An appropriate number of procedures seems to be required to reduce the TAo-TAVI complication rate.