Analysis of complications in transfemoral transcatheter aortic valve implantation: a single-center study.

Abstract

Transfemoral access is the prevailing approach for transcatheter aortic valve implantation (TAVI) in contemporary practice, with a shift from surgical arteriotomy to a percutaneous arterial approach. This study assesses long- and short-term mortality, along with Valve Academic Research Consortium 2 (VARC 2)-defined complications in percutaneous transfemoral approach (PTA) TAVI. Furthermore, it explores the impact of the learning curve on procedural outcomes. The study includes 600 patients undergoing PTA TAVI at the National Institute of Cardiology, Warsaw, Poland (January 2009-September 2020). Retrospective data comparison involves two groups: early experience (first 200 patients) and late experience (next 400). The primary endpoint (composite of life-threatening bleeding, major vascular complication, or one-month death) occurred less in the late experience group (28.0% vs. 17.5%, P = 0.003). Late experience also showed fewer vascular complications (19.0% vs. 10.7%, P = 0.005) and major bleeding (17.5% vs. 8.5%, P = 0.001). Propensity matching yielded similar trends, including reduced pacemaker implantation (22.8% vs. 10.9%, P = 0.03) and shorter hospitalization (11 [8-18] vs. 7 [6-12] days, P <0.001). The late experience group in PTA TAVI exhibits significantly reduced periprocedural complications, indicating the positive impact of accumulated expertise.