Study Evaluates Individual Operator Experience and Outcomes of TAVR
December 17, 2018—Online in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions, Arash Salemi, MD, et al published findings from a study that aimed to assess the impact of individual operator experience on transfemoral transcatheter aortic valve replacement (TAVR) outcomes.
Using the New York Statewide Planning and Research Cooperative System, the investigators analyzed data from 8,771 transfemoral TAVR procedures performed by 207 operators between 2012 and 2016. Operator volume was defined as the number of TAVR procedures performed during 1 year before the index procedure. Hierarchical and restrictive cubic spline regression models were used to evaluate the impact of individual operator experience on risk-adjusted in-hospital outcomes.
The primary outcome was a composite of in-hospital mortality, stroke, and/or acute myocardial infarction. Secondary outcomes were the individual components of the primary outcome.
As reported in JACC: Cardiovascular Interventions, the investigators found that after adjusting for hospital and physician characteristics, patients undergoing TAVR performed by high-volume physicians (≥ 80 procedures per year) had a significantly lower risk for death, stroke, or acute myocardial infarction (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.37–0.93) compared with those treated by low-volume physicians (< 24 procedures per year).
Being treated by operators who had performed 200 procedures during the previous year was associated with significantly lower risks for postprocedural stroke (OR, 0.41; 95% CI, 0.17–0.97) and composite events (OR, 0.45; 95% CI, 0.26–0.78). This relationship was nonlinear, and a sensitivity analysis excluding the first 10, 20, and 30 procedures for each operator mitigated the effect of the initial learning curve.
The data show that increased TAVR experience of operators is associated with improved risk-adjusted in-hospital outcomes, and these results have potentially important implications for individual training and hospital programs in TAVR, concluded the investigators in JACC: Cardiovascular Interventions.