Learning Curve for In-Hospital Mortality of Transcatheter Aortic Valve Replacement: Insights from the Brazilian National Registry.

Autor:	Bernardi FLM; Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil., Abizaid AA; Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil., Brito FS Jr; Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.; Hospital Sírio-Libanês, São Paulo, SP - Brasil., Lemos PA; Hospital Israelita Albert Einstein, São Paulo, SP - Brasil., Siqueira DAA; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil., Costa RA; Hospital Sírio-Libanês, São Paulo, SP - Brasil.; Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil., Leite REGS; Instituto de Cardiologia, Porto Alegre, RS - Brasil., Mangione FM; Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil., Thiago LEKS; Hospital SOS Cárdio, Florianópolis, SC - Brasil., Mangione JA; Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil., Lima VC; Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS - Brasil., Oliveira AD; Hospital Santa Izabel, Salvador, BA - Brasil., Marino MA; Hospital Madre Teresa, Belo Horizonte, MG - Brasil., Cardoso CJF; Hospital Naval Marcilio Dias, Rio de Janeiro, RJ - Brasil., Caramori PRA; Hospital São Lucas da PUCRS, Porto Alegre, RS - Brasil., Tumelero R; Universidade de Passo Fundo, Passo Fundo, RS - Brasil., Portela ALF; Associação Piauiense de Combate ao Câncer, Teresina, PI - Brasil., Prudente M; Hospital Encore, Goiânia, GO - Brasil., Henriques LA; Hospital Albert Sabin, Juiz de Fora, MG - Brasil., Souza FS; Hospital Universitário Professor Edgard Santos, Salvador, BA - Brasil.; Hospital Cardio-Pulmonar, Salvador, BA - Brasil., Bezerra CG; Hospital Aliança Rede D´Or, Salvador, BA - Brasil., Prado GFA Jr; Hospital Israelita Albert Einstein, São Paulo, SP - Brasil., Freitas LZF; Universidade Federal de Goiás, Goiânia, GO - Brasil., Nogueira EF; Hospital do Coração de Londrina, Londrina, PR - Brasil., Meireles GCX; Instituto de Assistência Médica ao Servidor Público Estadual de São Paulo, São Paulo, SP - Brasil., Pope RB; Hospital Hans Dieter Schmidt, Joinville, SC - Brasil., Guerios E; Universidade Federal do Paraná - Hospital de Clinicas, Curitiba, PR - Brasil., Andrade PB; Santa Casa de Misericórdia de Marília, Marilia, SP - Brasil., Santos LM; Hospital Santa Lúcia, Brasília, DF - Brasil., Marchi MFS; Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil., Fundão NHF; Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil., Ribeiro HB; Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP - Brasil.
Jazyk:	Portuguese; English
Zdroj:	Arquivos brasileiros de cardiologia [Arq Bras Cardiol] 2024 Jun; Vol. 121 (7), pp. e20230622.
DOI:	10.36660/abc.20230622
Abstrakt:	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.
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu