Developing proficiency in a transcatheter aortic valve replacement program: lessons from a single academic center's learning curve

Aortic stenosis (AS) is a prevalent and high-mortality valve disease. Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment with outcomes often better than surgery, requiring a multidisciplinary team. This study analyzes outcomes and trends from a high-volume TAVR program in an urban, low-income setting since 2017 to guide future practices.

Medical records of patients that underwent TAVR were analyzed retrospectively from 2018 to 2023, dividing them into two cohorts to analyze trends in operative details, complications, length of stay (LOS), and readmission/mortality rates. The learning curve (LC) was assessed by operative time.

Risk-adjusted cumulative sum (RA-CUSUM) analysis identified the transition point at case 76, dividing the cohort into early LC phase group (n = 76) and post-LC phase group (n = 190). Median operative time decreased from 106 to 80 minutes. After adjustment, operative time was 14% shorter in the post-learning-curve cohort (GMR 0.86, 95% CI 0.77-0.96; p = 0.005).

Operative time serves as a useful benchmark for institutional maturation. In our program, reaching 76 cases represented a key transition point toward optimized workflows, enhanced efficiency, and improved resource utilization.