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

Introduction: 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. Objectives: 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. Patients and methods: 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). Results: 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). Conclusions: The late experience group in PTA TAVI exhibits significantly reduced periprocedural complications, indicating the positive impact of accumulated expertise.