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Introduction: Transcatheter aortic valve replacement (TAVR) has emerged for high-risk patients with severe aortic stenosis (AS). In this study, we investigated change in the safety and efficiency of the TAVR procedure and patients’ outcomes by comparison of the first 100, second 100, and the last 100 patients.
Methods: From March-2012 to June-2016, 600 patients underwent TAVR at our center. Three hundred patients were selected for this study and were categorized in three groups; group-A: first to 100^th patient, group-B: 101^st-200^th patient, and group-C: 501^st-600^th patient.
Results: 300 patients with mean age of 79.10±8.93 years were included. Fluoroscopy time and dose were significantly lower in group-B comparing group-A, 12.19±6.39 minutes versus 18.6±10.59 minutes (p<0.001) and 568.27±425.68 mGy versus 2082.42±1943.61 mGy (p<0.001), respectively. Mean of contrast volume was 106.06±47.61ml in group-A and 76.50±27.39ml in group-B (p<0.001). Fluoroscopy dose and contrast volume were significantly lower in group-C than group-B (285.4±276.20 mGy versus 568.27±425.68 mGy, p<0.001 and 56.85±37.72ml versus 76.50±27.39ml, p<0.001, respectively). Operation and incision times were also significantly lower in group-B than group-A, 136.61±32.13 versus 156.84±54.30, p<0.001 and 98.90±28.26 versus 122.58±52.93, p<0.001. The operation and incision times were even lower in group-C comparing group-B, 106.81±35.10 versus 136.61±32.13 and 54.89±23.87 versus 98.90±28.26, (both p-values<0.001). Acute kidney injury rate was 26% (n=26) in group-A versus 23% (n=23) in group-B (p=0.743), and 1% (n=1) in group-C (p<0.001). Five (5%) strokes in group-A and 2 (2%) strokes in group-B were detected (p=0.44), but no patient in group-C had stroke (p=0.059). In-hospital mortality was 5% (n=5) in group-A, 4% (n=4) in group-B, and 1% (n=1) in group-C (p=0.21).
Conclusion: Increased experience with TAVR procedures increases the operators’ expertise, making the TAVR both more efficient and perhaps safer. The trend in patients’ outcome improvement would likely be significant with comparison of larger group of patients in a longer period of time.
Table-1. Comparison of preoperative and post-operative characteristics

Variable name	Group A	Group B	P-value (A vs. B)	Group C	P-value (B vs. C)
Male, N (%)	50 (50)	54 (54)	0.67	58 (58)	0.66
Age, year, mean±SD	80.64±8.13	78.78±8.12	0.10	77.85±10.25	0.48
Diabetes, N (%)	31 (31)	37 (37)	0.45	36 (36)	1.0
Peripheral artery disease, N (%)	14 (14)	21 (21)	0.26	29 (29)	0.25
Hypertension, N (%)	71 (71)	88 (88)	0.005	91 (91)	0.64
Heart failure, N (%)	35 (35)	59 (59)	0.001	25 (25)	<0.001
Preoperative aortic valve gradient, mmHg, mean±SD	46.53±18.6	42.72±17.17	0.14	38.98±14.24	0.103
Preoperative aortic valve area, cm2, mean±SD	0.61±0.28	0.70±0.20	0.02	0.66±0.26	0.301
Ejection fraction, %, mean±SD	51.43±15.75	52.36±14.05	0.66	50.12±14.62	0.271
Creatinine, mg/dl, mean±SD	1.18±1.07	1.28±1.11	0.51	1.30±1.01	0.87
Operation time (minutes), mean±SD	156.84±54.30	136.61±32.13	<0.001	106.81±35.10	<0.001
Incision time (minutes), mean±SD	122.58±52.93	98.90±28.26	<0.001	54.89±23.78	<0.001
Length of ICU admission (hours), mean±SD	94.46±88.53	93.58±110.18	0.95	56.14±81.80	0.007
Length of hospital stay (day), mean±SD	7.92±6.25	6.72±4.94	0.14	2.57±2.49	<0.001
Post-operative acute kidney injury, N (%)	26 (26)	23 (23)	0.74	1 (1)	<0.001
Post-operative stroke/TIA, N (%)	5 (5)	2 (2)	0.44	0 (0)	0.49
ICU readmission, N (%)	2 (2)	4 (4)	0.68	0 (0)	0.12
Re-intubation, N (%)	6 (6)	7 (7)	0.78	0 (0)	0.014
In-hospital death, N (%)	5 (5%)	4 (4%)	1.0	1 (1)	0.36