Produção Nacional
Revisado por pares
Learning Curve for In-Hospital Mortality of Transcatheter Aortic Valve Replacement: Insights from the Brazilian National Registry
2024; Sociedade Brasileira de Cardiologia (SBC); Volume: 121; Issue: 7 Linguagem: Inglês
10.36660/abc.20230622i
ISSN1678-4170
AutoresFernando Luiz de Melo Bernardi, Alexandre Abizaid, Fábio Sândoli de Brito, Pedro A. Lemos, Dimytri Siqueira, Ricardo A. Costa, Rogério Sarmento‐Leite, Fernanda Mangione, Luiz Eduardo Koenig São Thiago, José Armando Mangione, Valter Correia de Lima, Adriano Dourado Oliveira, Marcos Maynar-Mariño, Carlos José Francisco Cardoso, Paulo Caramori, Rogério Tumelero, Antenor Lages Fortes Portela, Maurício Prudente, Leônidas Alvarenga Henriques, Fábio Solano de Freitas Souza, Cristiano Guedes Bezerra, Guy Prado, Leandro Zacaris Figueiredo Freitas, Ederlon Ferreira Nogueira, George César Ximenes Meireles, Renato Bastos Pope, Ênio Eduardo Guérios, Pedro Beraldo de Andrade, Luciano de Moura Santos, Maurício Felippi de Sá Marchi, Nelson Henrique Fantin Fundão, Henrique Barbosa Ribeiro,
Tópico(s)Aortic Disease and Treatment Approaches
ResumoAbstract Background Robust data on the learning curve (LC) of transcatheter aortic valve replacement (TAVR) are lacking in developing countries. Objective To assess TAVR’s LC in Brazil over time. Methods We analyzed data from the Brazilian TAVR registry from 2008 to 2023. Patients from each center were numbered chronologically in case sequence numbers (CSNs). LC was performed using restricted cubic splines adjusted for EuroSCORE-II and the use of new-generation prostheses. Also, in-hospital outcomes were compared between groups defined according to the level of experience based on the CSN: 1st to 40th (initial-experience), 41st to 80th (early-experience), 81st to 120th (intermediate-experience), and over 121st (high-experience). Additional analysis was performed grouping hospitals according to the number of cases treated before 2014 (>40 and ≤40 procedures). The level of significance adopted was <0.05. Results A total of 3,194 patients from 25 centers were included. Mean age and EuroSCORE II were 80.7±8.1 years and 7±7.1, respectively. LC analysis demonstrated a drop in adjusted in-hospital mortality after treating 40 patients. A leveling off of the curve was observed after case #118. In-hospital mortality across the groups was 8.6%, 7.7%, 5.9%, and 3.7% for initial-, early-, intermediate-, and high-experience, respectively (p<0.001). High experience independently predicted lower mortality (OR 0.57, p=0.013 vs. initial experience). Low-volume centers before 2014 showed no significant decrease in the likelihood of death with gained experience, whereas high-volume centers had a continuous improvement after case #10. Conclusion A TAVR LC phenomenon was observed for in-hospital mortality in Brazil. This effect was more pronounced in centers that treated their first 40 cases before 2014 than those that reached this milestone after 2014.
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