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. 2017:2017:7524925.
doi: 10.1155/2017/7524925. Epub 2017 Jan 26.

Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement

Sergey Gurevich  1 , Ranjit John  1 , Rosemary F Kelly  1 , Ganesh Raveendran  1 , Gregory Helmer  1 , Demetris Yannopoulos  1 , Timinder Biring  1 , Brett Oestreich  1 , Santiago Garcia  2
Affiliations

Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement

Sergey Gurevich et al. Cardiol Res Pract. 2017.

Abstract

Objectives. To evaluate whether collaboration between existing and new transcatheter aortic valve replacement (TAVR) programs could help reduce the number of cases needed to achieve optimal efficiency. Background. There is a well-documented learning curve for achieving procedural efficiency and safety in TAVR procedures. Methods. A multidisciplinary collaboration was established between the Minneapolis VA Medical Center (new program) and the University of Minnesota (established program since 2012, n = 219) 1 year prior to launching the new program. Results. 269 patients treated with TAVR (50 treated in the first year at the new program). Mean age was 76 (±18) years and STS score was 6.8 (±6). Access included transfemoral (n = 35, 70%), transapical (n = 8, 16%), transaortic (n = 2, 4%), and subclavian (n = 5, 10%) types. Procedural efficiency (procedural time 158 ± 59 versus 148 ± 62, p = 0.27), device success (96% versus 87%, p = 0.08), length of stay (5 ± 3 versus 6 ± 7 days, p = 0.10), and safety (in hospital mortality 4% versus 6%, p = 0.75) were similar between programs. We found no difference in outcome measures between the first and last 25 patients treated during the first year of the new program. Conclusions. Establishing a partnership with an established program can help mitigate the learning curve associated with these complex procedures.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Procedural efficiency of new TAVR program relative to established program (a) and comparison of results of first versus second half of the first year of the new TAVR program.
Figure 2
Figure 2
Procedural complications, length of stay, and in-hospital mortality.
See this image and copyright information in PMC

References

    1. Murzi M., Cerillo A. G., Bevilacqua S., Gilmanov D., Farneti P., Glauber M. Traversing the learning curve in minimally invasive heart valve surgery: a cumulative analysis of an individual surgeon's experience with a right minithoracotomy approach for aortic valve replacement. European Journal of Cardio-thoracic Surgery. 2012;41(6):1242–1246. doi: 10.1093/ejcts/ezr230. - DOI - PubMed
    1. Ahmadi R., Willfort A., Lang W., et al. Carotid artery stenting: effect of learning curve and intermediate-term morphological outcome. Journal of Endovascular Therapy. 2001;8(6):539–546. doi: 10.1583/1545-1550(2001)00838;<0539:caseol>2.0.co;2. - DOI - PubMed
    1. Alli O., Rihal C. S., Suri R. M., et al. Learning curves for transfemoral transcatheter aortic valve replacement in the PARTNER-I trial: technical performance. Catheterization and Cardiovascular Interventions. 2016;87(1):154–162. doi: 10.1002/ccd.26120. - DOI - PubMed
    1. https://www.advisory.com/research/cardiovascular-roundtable/cardiovascul....
    1. Leon M. B., Smith C. R., Mack M. J., et al. Transcatheter or surgical Aortic-valve replacement in intermediate-risk patients. The New England Journal of Medicine. 2016;374:1609–1620. doi: 10.1056/nejmoa1514616. - DOI - PubMed