title: Impact of procedural volume on outcome optimization in transaortic transcatheter aortic valve implantation.
abstract: BACKGROUND
  An adequate procedural volume seems to be required to minimize the complication rate in TAVI. However, very few studies have investigated the relationship between procedural volume and outcomes in TAVI especially via the transaortic approach. The aim of this study was to evaluate the effect of procedural volume on the outcomes of transaortic TAVI (TAo-TAVI).
  
  
  METHODS
  257 consecutive TAo-TAVI cases performed by 2 cardiac surgeons between January 2011 and June 2014 were included in the current analysis. Cumulative sum (CUSUM) failure analysis of combined 30-day safety endpoints was used in order to evaluate the learning curves. We divided the cases into two groups: early experience and late experience, respectively. Procedure and outcome variables were compared.
  
  
  RESULTS
  The CUSUM analysis revealed a learning curve regarding the occurrence of adverse events at 30days with an improvement after the initial 128 cases. We divided the cases into two groups (early group: cases 1 to 128; late group: cases 129 to 257). Although the rate of 30-day mortality was not significantly different between the 2 groups (11% and 7%, p=0.268), the incidence of adverse events such as life-threatening bleeding, stroke and AKI was significantly decreased in the late phase group (9% and 1%, p=0.002; 5% and 0%, p=0.014; 16% and 6%, p=0.002, respectively).
  
  
  CONCLUSIONS
  The incidence of adverse events was significantly decreased in the late phase group. An appropriate number of procedures seems to be required to reduce the TAo-TAVI complication rate.
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 Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Mauro
authors.initials: M
authors.lastname: Romano
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.
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 Cardiovascular Surgery and Transcatheter Heart and Vascular Therapies, Institut Cardiovasculaire Paris Sud, Massy, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Farge
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: Bernard
authors.initials: B
authors.lastname: Chevalier
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality* / Q000601:surgery*; D002983:Clinical Competence / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D009026:Mortality / Q000639:trends; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D065467:Transcatheter Aortic Valve Replacement / Q000401:mortality* / Q000592:standards / Q000639:trends; D016896:Treatment Outcome
keywords: Severe symptomatic aortic stenosis; Transaortic approach; Transcatheter aortic valve implantation