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Individual Operator Experience and Outcomes in Transcatheter Aortic Valve Replacement
Arash Salemi1, Art Sedrakyan2, Jialin Mao2
1Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
JACC. Cardiovascular Interventions
|December 17, 2018
Summary
Higher operator experience in transcatheter aortic valve replacement (TAVR) significantly reduces in-hospital complications. Increased TAVR volume by physicians leads to better patient outcomes, highlighting the importance of operator skill.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Health Services Research
Background:
- Transcatheter aortic valve replacement (TAVR) volume-outcome relationships are not well-established at the individual operator level.
- Assessing individual operator experience is crucial for understanding TAVR procedural success.
Purpose of the Study:
- To evaluate the impact of individual operator experience on outcomes of transfemoral transcatheter aortic valve replacement (TAVR).
Main Methods:
- Analysis of 8,771 transfemoral TAVR procedures by 207 operators (2012-2016) using New York Statewide data.
- Operator volume defined as procedures performed in the prior year; risk-adjusted in-hospital outcomes assessed using regression models.
- Primary outcome: composite of in-hospital mortality, stroke, or acute myocardial infarction.
Main Results:
- High-volume physicians (≥80 TAVR/year) showed significantly lower risk for death, stroke, or myocardial infarction (OR 0.59).
- Operators performing ≥200 TAVR procedures/year had significantly lower risks of stroke and composite events (OR 0.41-0.45).
- A nonlinear relationship was observed, with initial learning curve effects mitigated by sensitivity analysis.
Conclusions:
- Increased operator experience in TAVR is linked to improved risk-adjusted in-hospital outcomes.
- Findings suggest significant implications for TAVR training programs and individual physician development.
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