Institutional experience and outcomes of transcatheter aortic valve replacement

Results from an international multicentre registry

Anthony W.A. Wassef, Sami Alnasser, Josep Rodes-Cabau, John G. Webb, Marco Barbanti, Yaqing Liu, Antonio J. Muñoz-García, Corrado Tamburino, Antonio E. Dager, Vicenç Serra, Ignacio J. Amat-Santos, Hatim Al Lawati, Marina Urena, Juan H. Alonso Briales, Luis Miguel Benitez, Bruno García del Blanco, Alberto San Roman, Akshay Bagai, Christopher E. Buller, Mark D. Peterson & 1 others Asim N. Cheema

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Despite rapidly increasing use of TAVR across institutions, limited data is available for the effect of procedural experience on TAVR outcomes. We investigate the relationship between institutional experience and TAVR outcomes. Methods 1953 patients undergoing TAVR at 8 international sites were grouped into chronological quantiles (Q) to assess temporal changes on procedural and clinical outcomes and multivariate logistic regression performed to determine predictors of device success, early safety and all-cause mortality. Results The mean age of patients was 81 ± 7 years and 991 (51%) were female. The quantiles comprised of first 62 cases for Q1, 63–133 for Q2, 134 to 242 for Q3 and 243 to 476 for Q4. Device success increased from Q1 to Q4 (78% vs 89%, p < 0.001) with significant improvement in the early safety endpoint (19% vs 10%, p < 0.001). All cause mortality reduced by half in Q4 compared to Q1 (8% vs 4%, p = 0.01) and rates of major vascular complications, major bleeding and valve embolization decreased with increasing experience. The multivariate analysis identified TAVR in Q3 and Q4 to be independently associated with higher device success and lower risk of complications. TAVR in Q4 was independently associated with lower mortality (OR 0.36 95% CI 0.19–0.70, p = 0.002). Conclusions Greater institutional experience with TAVR procedures improves device success and clinical outcomes. An experience of > 242 cases is independently associated with lower mortality. These findings have important implications for defining minimum volume criteria for institutions and training standards for TAVR procedure.

Original languageEnglish
Pages (from-to)222-227
Number of pages6
JournalInternational Journal of Cardiology
Volume245
DOIs
Publication statusPublished - Oct 15 2017

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Registries
Equipment and Supplies
Mortality
Logistic Models
Safety
Transcatheter Aortic Valve Replacement

Keywords

  • Aortic stenosis
  • Complications
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Medicine(all)
  • Cardiology and Cardiovascular Medicine

Cite this

Institutional experience and outcomes of transcatheter aortic valve replacement : Results from an international multicentre registry. / Wassef, Anthony W.A.; Alnasser, Sami; Rodes-Cabau, Josep; Webb, John G.; Barbanti, Marco; Liu, Yaqing; Muñoz-García, Antonio J.; Tamburino, Corrado; Dager, Antonio E.; Serra, Vicenç; Amat-Santos, Ignacio J.; Al Lawati, Hatim; Urena, Marina; Alonso Briales, Juan H.; Benitez, Luis Miguel; del Blanco, Bruno García; Roman, Alberto San; Bagai, Akshay; Buller, Christopher E.; Peterson, Mark D.; Cheema, Asim N.

In: International Journal of Cardiology, Vol. 245, 15.10.2017, p. 222-227.

Research output: Contribution to journalArticle

Wassef, AWA, Alnasser, S, Rodes-Cabau, J, Webb, JG, Barbanti, M, Liu, Y, Muñoz-García, AJ, Tamburino, C, Dager, AE, Serra, V, Amat-Santos, IJ, Al Lawati, H, Urena, M, Alonso Briales, JH, Benitez, LM, del Blanco, BG, Roman, AS, Bagai, A, Buller, CE, Peterson, MD & Cheema, AN 2017, 'Institutional experience and outcomes of transcatheter aortic valve replacement: Results from an international multicentre registry', International Journal of Cardiology, vol. 245, pp. 222-227. https://doi.org/10.1016/j.ijcard.2017.07.079
Wassef, Anthony W.A. ; Alnasser, Sami ; Rodes-Cabau, Josep ; Webb, John G. ; Barbanti, Marco ; Liu, Yaqing ; Muñoz-García, Antonio J. ; Tamburino, Corrado ; Dager, Antonio E. ; Serra, Vicenç ; Amat-Santos, Ignacio J. ; Al Lawati, Hatim ; Urena, Marina ; Alonso Briales, Juan H. ; Benitez, Luis Miguel ; del Blanco, Bruno García ; Roman, Alberto San ; Bagai, Akshay ; Buller, Christopher E. ; Peterson, Mark D. ; Cheema, Asim N. / Institutional experience and outcomes of transcatheter aortic valve replacement : Results from an international multicentre registry. In: International Journal of Cardiology. 2017 ; Vol. 245. pp. 222-227.
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T2 - Results from an international multicentre registry

AU - Wassef, Anthony W.A.

AU - Alnasser, Sami

AU - Rodes-Cabau, Josep

AU - Webb, John G.

AU - Barbanti, Marco

AU - Liu, Yaqing

AU - Muñoz-García, Antonio J.

AU - Tamburino, Corrado

AU - Dager, Antonio E.

AU - Serra, Vicenç

AU - Amat-Santos, Ignacio J.

AU - Al Lawati, Hatim

AU - Urena, Marina

AU - Alonso Briales, Juan H.

AU - Benitez, Luis Miguel

AU - del Blanco, Bruno García

AU - Roman, Alberto San

AU - Bagai, Akshay

AU - Buller, Christopher E.

AU - Peterson, Mark D.

AU - Cheema, Asim N.

PY - 2017/10/15

Y1 - 2017/10/15

N2 - Background Despite rapidly increasing use of TAVR across institutions, limited data is available for the effect of procedural experience on TAVR outcomes. We investigate the relationship between institutional experience and TAVR outcomes. Methods 1953 patients undergoing TAVR at 8 international sites were grouped into chronological quantiles (Q) to assess temporal changes on procedural and clinical outcomes and multivariate logistic regression performed to determine predictors of device success, early safety and all-cause mortality. Results The mean age of patients was 81 ± 7 years and 991 (51%) were female. The quantiles comprised of first 62 cases for Q1, 63–133 for Q2, 134 to 242 for Q3 and 243 to 476 for Q4. Device success increased from Q1 to Q4 (78% vs 89%, p < 0.001) with significant improvement in the early safety endpoint (19% vs 10%, p < 0.001). All cause mortality reduced by half in Q4 compared to Q1 (8% vs 4%, p = 0.01) and rates of major vascular complications, major bleeding and valve embolization decreased with increasing experience. The multivariate analysis identified TAVR in Q3 and Q4 to be independently associated with higher device success and lower risk of complications. TAVR in Q4 was independently associated with lower mortality (OR 0.36 95% CI 0.19–0.70, p = 0.002). Conclusions Greater institutional experience with TAVR procedures improves device success and clinical outcomes. An experience of > 242 cases is independently associated with lower mortality. These findings have important implications for defining minimum volume criteria for institutions and training standards for TAVR procedure.

AB - Background Despite rapidly increasing use of TAVR across institutions, limited data is available for the effect of procedural experience on TAVR outcomes. We investigate the relationship between institutional experience and TAVR outcomes. Methods 1953 patients undergoing TAVR at 8 international sites were grouped into chronological quantiles (Q) to assess temporal changes on procedural and clinical outcomes and multivariate logistic regression performed to determine predictors of device success, early safety and all-cause mortality. Results The mean age of patients was 81 ± 7 years and 991 (51%) were female. The quantiles comprised of first 62 cases for Q1, 63–133 for Q2, 134 to 242 for Q3 and 243 to 476 for Q4. Device success increased from Q1 to Q4 (78% vs 89%, p < 0.001) with significant improvement in the early safety endpoint (19% vs 10%, p < 0.001). All cause mortality reduced by half in Q4 compared to Q1 (8% vs 4%, p = 0.01) and rates of major vascular complications, major bleeding and valve embolization decreased with increasing experience. The multivariate analysis identified TAVR in Q3 and Q4 to be independently associated with higher device success and lower risk of complications. TAVR in Q4 was independently associated with lower mortality (OR 0.36 95% CI 0.19–0.70, p = 0.002). Conclusions Greater institutional experience with TAVR procedures improves device success and clinical outcomes. An experience of > 242 cases is independently associated with lower mortality. These findings have important implications for defining minimum volume criteria for institutions and training standards for TAVR procedure.

KW - Aortic stenosis

KW - Complications

KW - Transcatheter aortic valve replacement

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