title: Evaluation of the learning curve for transcatheter aortic valve implantation via the transfemoral approach.
abstract: BACKGROUND
  The aim of this study was to evaluate the learning curve in performing transfemoral TAVI (TF-TAVI).
  
  
  METHODS
  Between October 2006 and October 2013, 312 consecutive TF-TAVI cases performed by 6 interventional cardiologists, using the Edwards Sapien valve and 104 using the CoreValve, were included in the present analysis. Cumulative sum (CUSUM) failure analysis of combined 30-day safety endpoint was used to evaluate learning curves.
  
  
  RESULTS
  The CUSUM analysis revealed a learning curve regarding the occurrence of 30-day adverse events with an improvement after the initial 86 cases using the Edwards valve and 40 cases using the CoreValve. We divided the Edwards valve cases into two groups (early experience: Cases 1 to 86; late experience: Cases 87 to 312). The rate of 30-day mortality and 1-year mortality significantly decreased in the late experience group (17% to 7%, p=0.019; 34% to 21%, p=0.035, respectively). We divided the CoreValve cases into two groups (early experience: Cases 1 to 40; late experience: Cases 41 to 104). The rate of 30-day mortality and 1-year mortality significantly decreased in the late experience group (20% to 6%, p=0.033; 38% to 15%, p=0.040, respectively). The groups including both valves were also analyzed after propensity-matching (early [n=52] vs late [n=52]). This model also showed that 30-day and 1-year mortality rates were significantly lower in the late experience group (13% to 1%, p=0.028; 34% to 20%, p=0.042, respectively).
  
  
  CONCLUSIONS
  An appropriate level of experience is needed to reduce the complication rate and mortality in TF-TAVI.
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Takahide
authors.initials: T
authors.lastname: Arai
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France. Electronic address: t.lefevre@angio-icps.com.
authors.forename: Thierry
authors.initials: T
authors.lastname: Lefèvre
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hovasse
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France; Department of Cardiology, Keio University School of Medicine, Tokyo, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Hayashida
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France; Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Watanabe
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: O'Connor
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cormier
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Erik
authors.initials: E
authors.lastname: Bouvier
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Morice
authors.affiliation: Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Chevalier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005263:Femoral Artery; D006350:Heart Valve Prosthesis; D006801:Humans; D053208:Kaplan-Meier Estimate; D059032:Learning Curve; D008297:Male; D011446:Prospective Studies; D011474:Prosthesis Design; D018570:Risk Assessment; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods; D016896:Treatment Outcome
keywords: Learning curve; Severe symptomatic aortic stenosis; Transcatheter aortic valve implantation