title: Usefulness of transesophageal echocardiography during implantation of the CoreValve percutaneous aortic prosthesis: influence of the learning curve.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the usefulness of transesophageal echocardiography during the implantation of the CoreValve percutaneous aortic prosthesis and the influence of the learning curve in its indications.
  
  
  METHODS
  From April 2008 to January 2010, 53 patients were treated for symptomatic severe aortic stenosis with a CoreValve percutaneous aortic prosthesis. Transesophageal echocardiography was performed during the procedure for two reasons: if a discrepancy between the measures of the aortic annulus arose before the implantation and to provide visualization if a complication occurred during the procedure. Patients were divided in to two groups based on the learning curve (group I:the first 25 patients, group II: all of the subsequent patients).
  
  
  RESULTS
  Thirty-six transesophageal echocardiographies were performed on 28 patients (53%).In 15 cases the indication was to assist us in determining the proper sized prosthesis, and in the other 21 cases it was performed due to a complication during the procedure. The numbers of intraprocedure transesophageal echocardiographies were similar in both learning-curve groups, (64% in group I vs. 71% in group II, P = 0.56) but the proportion of the studies indicated by serious complications was significantly lower in the second period of the learning curve (67% in group I vs. 17% in group II, P < 0.05).
  
  
  CONCLUSIONS
  In our experience, transesophageal echocardiography was very useful in more than one-half of the patients during the implantation of the CoreValve percutaneous aortic prosthesis. After overcoming the learning curve, its indication due to serious procedure-related complications decreased significantly.
authors.affiliation: Hospital Universitario Reina Sofia, Cardiology, Avenida Menendez Pidal, S/N, Cordoba 14004, Spain. laura_cejudi@hotmail.com
authors.forename: Laura
authors.initials: L
authors.lastname: Cejudo Díaz del Campo
authors.forename: Dolores Mesa
authors.initials: DM
authors.lastname: Rubio
authors.forename: Martin Ruiz
authors.initials: MR
authors.lastname: Ortiz
authors.forename: Mónica Delgado
authors.initials: MD
authors.lastname: Ortega
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.forename: Soledad Ojeda
authors.initials: SO
authors.lastname: Pineda
authors.forename: Elena Villanueva
authors.initials: EV
authors.lastname: Fernandez
authors.forename: Jose Lopez
authors.initials: JL
authors.lastname: Aguilera
authors.forename: Jose
authors.initials: J
authors.lastname: Suarez de Lezo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D016009:Chi-Square Distribution; D002983:Clinical Competence; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D059032:Learning Curve; D008297:Male; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012720:Severity of Illness Index; D016896:Treatment Outcome