Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement

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.

Trans-catheter aortic valve replacement program in a community hospital – Comparison with US national data

“…Sapien XT was used in the first 8 cases, after which the Sapien 3 was used in essentially all cases. The use of the Edwards Sapien XT (2 nd generation) and Sapien 3(3 rd generation) with accompanying team [ 25 ] and the use of multislice computed tomography to assess aortic annulus dimensions for appropriate valve sizing [ 26 ] can explain the relatively short learning curve and the satisfactory early outcome achieved in intermediate as well as high risk TAVR patients.…”

Outcomes of intermediate‐risk patients treated with transcatheter and surgical aortic valve replacement in the Veterans Affairs Healthcare System: A single center 20‐year experience

“…This group (S3 registry) was selected because it provided the basis for FDA approval of TAVR for intermediate‐risk patients. S3 is the most common valve type used in the US and in our program .…”

2018 AATS/ACC/SCAI/STS expert consensus systems of care document: Operator and institutional recommendations and requirements for transcatheter aortic valve replacement

“…Prior to expanding into alternative access, a new TAVR program should first complete at least 80 TAVRs using transfemoral access with an STS/ACC TVT Registry 30‐day all‐cause mortality above the bottom 25% of all TAVR programs for two consecutive quarters/year. The writing committee's consensus regarding the required 80 TAVR procedures was based on information from referenced articles and expert opinion . Alliances should be established between low‐volume, high‐quality programs serving geographic isolated areas, or programs caring for underserved populations and high‐volume, high‐quality programs to care for patients needing alternative access and the higher‐risk complex patient population needing TAVR.…”

“…It is expected that their increased survival of 5-10 years post-TAVR will provide the opportunity to assess the incidence, frequency, and associated factors leading to structural valve deterioration Frequency of leaflet thrombosis of tissue valves, time of onset, association with clinical events, modification with anticoagulation, and optimal duration of anticoagulation information from referenced articles and expert opinion. 7,9,10,[73][74][75][76][77][78][79][80] Alliances should be established between low-volume, high-quality programs serving geographic isolated areas, or programs caring for underserved populations and high-volume, high-quality programs to care for patients needing alternative access and the higher-risk complex patient population needing TAVR. of procedures for eligibility at that site to become a program.…”