The training and learning process of transseptal puncture using a modified technique.

Area of Science:

• Interventional Cardiology
• Medical Training and Education
• Cardiac Catheterization Procedures

Background:

• Transseptal (TS) puncture is a crucial technique in modern cardiac interventions.
• Traditional TS puncture methods continue to evolve.
• A modified technique using the coronary sinus catheter as the sole landmark for TS puncture under fluoroscopy was developed.

Purpose of the Study:

• To prospectively evaluate the training and learning curve associated with this modified TS puncture technique.
• To assess the efficacy and safety of the modified technique in a training setting.

Main Methods:

• A prospective study involving 120 consecutive patients undergoing TS puncture.
• Three trainees with no prior TS catheterization experience performed the procedure under the guidance of an experienced trainer.
• Key parameters analyzed included puncture success rate, procedure time, fluoroscopic time, and radiation dose.
• Learning curve analysis was performed using curve-fitting methodology.

Main Results:

• The first attempt at TS crossing was successful in 82% of patients, with an overall success rate of 94% after a second attempt.
• The average starting procedure time was 4.1 minutes, reaching a learning plateau of 1.2 minutes.
• The estimated mean learning rate for procedure time was achieved around 25 cases.
• The learning curve analysis indicated that approximately 29 punctures are needed to overcome the steepest learning phase.

Conclusions:

• The modified TS puncture technique is a simple, safe, economic, and effective method for training purposes.
• The study provides statistical evidence on the number of procedures required for trainees to achieve proficiency.
• This technique offers a valuable approach for training new operators in transseptal puncture.