Transcatheter aortic valve implantation in the first 500 patients: a single-center retrospective study

To determine the procedural characteristics, results, and long-term outcomes of the first 500 consecutive patients undergoing transcatheter aortic valve implantation (TAVI) at the MC Medicor International Center for Cardiovascular Diseases Izola (Slovenia).

Data were collected from the institutional registry. The date of death was obtained from the National BIRPIS system by using the patient's health insurance card number. The difference in 30-day mortality was assessed between two consecutive cohorts of 250 patients, patients who received self-expandable (SEV) and those with balloon-expandable (BEV) valves, and between patients ≤80 and >80 years old.

Between December 2016 and September 2023, 500 patients (80±6 years, 52% men, EuroScore II, 4.09±4.11), including 3.2% with degenerated surgical prosthesis, underwent TAVI. After predilatation (57%), SEV was implanted in 87.5% and BEV in 12.5% of the patients. The mean postprocedural gradient was 10±4 mm Hg, with more than moderate regurgitation in 0.4%. Emergency cardiac/vascular surgery was performed in 1.4%, and stroke occurred in 0.8%. The new permanent pacemaker (PPM) rate decreased from 19% to 7% (P<0.001) in the second cohort, and the mean postprocedural transaortic gradient was significantly lower after SEV compared with BEV (9±4 vs 13±4 mm Hg; P<0.001). There was no difference in 30-day mortality between the first and second cohort of 250 patients (1.2% vs 1.2%; P=1.000), cohorts of 50 patients from number 0 to 500 (0% vs 2.0%; P=0.391), SEV and BEV groups (0.9% vs 1.6%; P=0.487), and patients ≤80 and >80 years old (2.0% vs 0.4%; P=0.119).

TAVI results in our study are comparable with international standards. PPM rate decreased over time, and postprocedural gradient was lower after SEV. Learning curve, type of valve, and patient age did not affect 30-day mortality.