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Learning curve in transradial cardiac catheterization: procedure-related parameters stratified by operators'
Ehab S Kasasbeh1, Babar Parvez, Robert L Huang
1Vanderbilt University Medical Center, Department of Internal Medicine, Division of Cardiovascular Medicine, 2200 Pierce Avenue, Nashville, TN 37232, USA. ehab.kasasbeh@vanderbilt.edu
Insights
Integrating radial artery access in cardiac catheterization labs significantly reduces fluoroscopy time for all operators. Higher-volume radial operators achieve better procedural efficiency, with improvements noted after approximately 25-75 cases.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Procedure Optimization
Background:
- Previous studies link increased procedural volume to decreased procedural time.
- Limited research exists on the long-term impact of integrating radial access over time.
Purpose of the Study:
- To evaluate the effect of radial artery access incorporation on fluoroscopy time, procedure time, and other procedural variables.
- To assess changes over a 27-month period following the adoption of the radial approach.
Main Methods:
- Analysis of 1112 consecutive diagnostic cardiac catheterizations using radial access (with/without PCI) from 2009-2011.
- Categorization of operators into high-, intermediate-, and low-volume groups based on radial approach utilization.
- Statistical analysis of procedural variables across operator groups and over time.
Main Results:
- Significant decrease in fluoroscopy time observed across all operator groups from 2009-2011 (P=.035).
- High-volume radial operators showed substantial reductions in fluoroscopy time compared to intermediate and low-volume groups (P<.001).
- Procedural parameter improvements were evident after ~25 cases, with further gains after ~75 cases.
Conclusions:
- Radial artery access incorporation effectively reduces fluoroscopy time for operators and groups in cardiac catheterization labs.
- Higher-volume radial operators demonstrate superior efficiency in procedure, room, and fluoroscopy times.
- Increased radial case volume leads to improved procedural parameters, even for lower-volume operators, with a defined learning curve.
Objective:
To determine whether radial artery access is associated with a reduction in fluoroscopy time, procedure time, and other procedural variables over a 27-month period during which the radial artery approach was incorporated in a single academic Medical Center.
Background:
Although previous studies have demonstrated a relationship between increased volume and decreased procedural time, no studies have looked at the integration of radial access over time.
Methods:
Data were collected from consecutive patients who presented to the Vanderbilt University Medical Center cardiac catheterization laboratory from January 1, 2009 to April 1, 2011. Patients who underwent radial access diagnostic catheterization with and without percutaneous coronary intervention were included in this study. A total of 1112 diagnostic cardiac catheterizations through the radial access site were analyzed. High-volume, intermediate-volume, and low-volume operators were grouped based on the percentage of procedures performed through a radial approach.
Results:
From 2009 to 2011, there was a significant decrease in fluoroscopy time in all operator groups for diagnostic catheterization (P=.035). The high-volume operator group had 1.88 and 3.66 minute reductions in fluoroscopy time compared to the intermediate- and low-volume operator groups, respectively (both P<.001). Likewise, the intermediate-volume operator group had a 1.77 minute improvement compared to the low-volume operator group, but this did not reach statistical significance (P=.102). The improvement in fluoroscopy time and other procedure-related parameters was seen after approximately 25 cases with further improvement after 75 cases.
Conclusions:
The incorporation of the radial access approach in the cardiac catheterization laboratory led to a decrease in fluoroscopy time for each operator and operator group over the last 3 years. Our data demonstrated that higher-volume radial operators have better procedure, room, and fluoroscopy times when compared to intermediate- and low-volume operators. However, lower-volume operators have a reduction in procedure-related parameters with increased radial cases. Number of procedures needed to become sufficient was demonstrated in the current study.
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