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.

This 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.

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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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