{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T04:32:19Z","timestamp":1772253139463,"version":"3.50.1"},"reference-count":18,"publisher":"Sociedade Brasileira de Cardiologia","issue":"7","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arq. Bras. Cardiol."],"abstract":"<jats:p>Resumo  Fundamento  Dados robustos sobre a curva de aprendizagem (LC) da substitui\u00e7\u00e3o da v\u00e1lvula a\u00f3rtica transcateter (TAVR) s\u00e3o escassos nos pa\u00edses em desenvolvimento.  Objetivo  Avaliar a LC da TAVR no Brasil ao longo do tempo.  M\u00e9todos  Analisamos dados do registro brasileiro de TAVR de 2008 a 2023. Pacientes de cada centro foram numerados cronologicamente em n\u00famero sequencial de caso (NSC). A LC foi realizada usando um spline c\u00fabico restrito ajustado para o EuroSCORE-II e o uso de pr\u00f3teses de nova gera\u00e7\u00e3o. Ainda, os desfechos hospitalares foram comparados entre grupos definidos de acordo com o n\u00edvel de experi\u00eancia, com base no NSC: 1\u00ba ao 40\u00ba caso (experi\u00eancia inicial), 41\u00ba ao 80\u00ba caso (experi\u00eancia b\u00e1sica), 81\u00ba ao 120\u00ba caso (experi\u00eancia intermedi\u00e1ria) e 121\u00ba caso em diante (experi\u00eancia alta). An\u00e1lises adicionais foram conduzidas de acordo com o n\u00famero de casos tratados antes de 2014 (&gt;40 e \u226440 procedimentos). O n\u00edvel de signific\u00e2ncia adotado foi p &lt;0,05.  Resultados  Foram inclu\u00eddos 3194 pacientes de 25 centros. A idade m\u00e9dia foi 80,7\u00b18,1 anos e o EuroSCORE II m\u00e9dio foi 7\u00b17,1. A an\u00e1lise da LC demonstrou uma queda na mortalidade hospitalar ajustada ap\u00f3s o tratamento de 40 pacientes. Um patamar de nivelamento na curva foi observado ap\u00f3s o caso 118. A mortalidade hospitalar entre os grupos foi 8,6%, 7,7%, 5,9%, e 3,7% para experi\u00eancia inicial, b\u00e1sica, intermedi\u00e1ria e alta, respectivamente (p&lt;0,001). A experi\u00eancia alta foi preditora independente de mortalidade mais baixa (OR 0,57, p=0,013 vs. experi\u00eancia inicial). Centros com baixo volume de casos antes de 2014 n\u00e3o mostraram uma redu\u00e7\u00e3o significativa na probabilidade de morte com o ganho de experi\u00eancia, enquanto centros com alto volume de casos antes de 2014 apresentaram uma melhora cont\u00ednua ap\u00f3s o caso de n\u00famero 10.  Conclus\u00e3o  Observou-se um fen\u00f4meno de LC para a mortalidade hospitalar do TAVR no Brasil. Esse efeito foi mais pronunciado em centros que trataram seus 40 primeiros casos antes de 2014 que naqueles que o fizeram ap\u00f3s 2014.<\/jats:p>","DOI":"10.36660\/abc.20230622","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T10:06:34Z","timestamp":1724061994000},"source":"Crossref","is-referenced-by-count":0,"title":["Curva de Aprendizagem da Mortalidade Hospitalar da Substitui\u00e7\u00e3o da V\u00e1lvula A\u00f3rtica Transcateter: Insights do Registro Nacional Brasileiro"],"prefix":"10.36660","volume":"121","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1267-0020","authenticated-orcid":false,"given":"Fernando Luiz de Melo","family":"Bernardi","sequence":"first","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandre A.","family":"Abizaid","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6260-9626","authenticated-orcid":false,"given":"F\u00e1bio S\u00e2ndoli de","family":"Brito Jr","sequence":"additional","affiliation":[{"name":"Universidade de S\u00e3o Paulo,  Brasil; Hospital S\u00edrio-Liban\u00eas,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6782-750X","authenticated-orcid":false,"given":"Pedro A.","family":"Lemos","sequence":"additional","affiliation":[{"name":"Hospital Israelita Albert Einstein,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4903-5274","authenticated-orcid":false,"given":"Dimytri Alexandre Alvim de","family":"Siqueira","sequence":"additional","affiliation":[{"name":"Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo Alves","family":"Costa","sequence":"additional","affiliation":[{"name":"Hospital S\u00edrio-Liban\u00eas,  Brasil; Instituto Dante Pazzanese de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9674-8528","authenticated-orcid":false,"given":"Rog\u00e9rio Eduardo Gomes Sarmento","family":"Leite","sequence":"additional","affiliation":[{"name":"Instituto de Cardiologia,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8212-1732","authenticated-orcid":false,"given":"Fernanda Marinho","family":"Mangione","sequence":"additional","affiliation":[{"name":"Hospital Benefic\u00eancia Portuguesa de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luiz Eduardo Koenig S\u00e3o","family":"Thiago","sequence":"additional","affiliation":[{"name":"Hospital SOS C\u00e1rdio,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 A.","family":"Mangione","sequence":"additional","affiliation":[{"name":"Hospital Benefic\u00eancia Portuguesa de S\u00e3o Paulo,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valter Correia de","family":"Lima","sequence":"additional","affiliation":[{"name":"Santa Casa de Miseric\u00f3rdia de Porto Alegre,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adriano Dourado","family":"Oliveira","sequence":"additional","affiliation":[{"name":"Hospital Santa Izabel,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marcos Ant\u00f4nio","family":"Marino","sequence":"additional","affiliation":[{"name":"Hospital Madre Teresa,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlos Jos\u00e9 Francisco","family":"Cardoso","sequence":"additional","affiliation":[{"name":"Hospital Naval Marcilio Dias,  Brasil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7895-8281","authenticated-orcid":false,"given":"Paulo R. 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