Is Individual Operator Experience Important in TAVR?

Courtesy of Dr. Carlos Fava.

Transcatheter aortic valve replacement (TAVR) has emerged as a successful alternative for inoperable patients and a non-inferior alternative for high- and intermediate-risk patients. While its evolution depending on site experience has been analyzed, there is currently very little information regarding the impact of operator individual experience.

Terapia endovascular en stroke: mucha evidencia y pocos operadores entrenadosThis study analyzed 8771 procedures performed by 207 different operators. High-volume operators were defined as those performing ≥80 procedures/year; intermediate-volume operators were those performing between 24 and 79 procedures/year, and low-volume operators, <24 procedures/year. The “learning curve” of these operators was excluded so as to mitigate the incidence of complications that could bias results.

 

Patients of high-volume operators had a significantly lower in-hospital risk for death, stroke, and acute myocardial infarction (odds ratio: 0.59; 95% confidence interval [CI]: 0.37 to 0.93) compared with low-volume operators.


Read also: PCI Mortality and Volume in One Center: Associated?


Patients of operators who performed >200 procedures during the prior year had a significantly lower risk for post-procedural stroke (odds ratio: 0.41; 95% confidence interval: 0.17 to 0.97) and less in-hospital events (odds ratio: 0.45; 95% confidence interval: 0.26 to 0.78).

 

Conclusion

Increased operator experience is associated with improvement in risk-adjusted in-hospital progress. These results are potentially important for individual training and hospital programs in TAVR.

 

Courtesy of Dr. Carlos Fava.

 

Original title: Individual Operator Experience and Outcomes in Transcatheter Aortic Valve Replacement.

Reference: Arash Salemi et al. Article in press.


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