Key result
Progressive institutional TAVR experience is linked to a ~96% reduction in acute kidney injury.
Why the study?
Does progressive institutional experience with transcatheter aortic valve replacement improve procedural efficiency and safety in patients with severe aortic stenosis?
Cohort (n=300)
No
Does progressive institutional experience with transcatheter aortic valve replacement improve procedural efficiency and safety in patients with severe aortic stenosis?
Progressive institutional experience with transcatheter aortic valve replacement is associated with significant improvements in procedural efficiency and reductions in complications such as acute kidney injury.
Institutional TAVR experience was associated with efficiency gains and lower AKI; leaves open multicenter validation of volume thresholds.
OBJECTIVE: Transcatheter aortic valve replacement is now commercially available for intermediate-risk, high-risk, or inoperable patients with severe aortic stenosis. In this study, we investigated change in the safety and efficiency of the transcatheter aortic valve replacement procedure at our institution and patient outcomes comparing our first 100, second 100, and last 100 patients. METHODS: From March 2012 to June 2016, 544 patients underwent transcatheter aortic valve replacement at our center. Three hundred patients were selected for this study and were categorized in the following three groups: group A, first to 100th patient; group B, 101st to 200th patient; and group C, 444th to 544th patient. Preoperative, intraoperative, and postoperative data were collected. RESULTS: Three hundred patients, 162 male (54%) male and 138 female (46%) with a mean ± SD age of 79.10 ± 8.93 years and mean ± SD society of thoracic surgeons' risk score of 7.47 ± 0.76 were included. Fluoroscopy time, operation time, and incision time significantly decreased form group A to group C (all P < 0.05). Mean of contrast volume was also the highest in group A and the lowest in group C (P < 0.001). Acute kidney injury rate was 26% (n = 26) in group A versus 23% (n = 23) in group B (P = 0.743), and only one patient in group C (group C vs. group B, P < 0.001). Strokes declined over time: five (5%) stroke in group A; two (2%) stroke in group B, and no patient in group C (group C vs. group B, P = 0.1, and group C vs. group A, P = 0.059). In-hospital mortality was 5% (n = 5) in group A, 4% (n = 4) in group B, and 1% in group C (P = 0.21). CONCLUSIONS: Progressive experience and technology advances with transcatheter aortic valve replacement procedures improved operators' expertise, making the transcatheter aortic valve replacement more efficient and safer over time.
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Aalaei‐Andabili et al. (2018) conducted a cohort in Severe aortic stenosis (n=300). Late procedural experience (last 100 patients) vs. Early procedural experience (first 100 patients) was evaluated on Acute kidney injury (p=<0.001). Progressive institutional experience with transcatheter aortic valve replacement significantly reduced acute kidney injury from 26% in the first 100 cases to 1% in the last 100 cases.
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