July 19, 2019
Study Evaluates Effect of Institutional Experience on Outcomes With MitraClip TMVR
July 19, 2019—A study using the Society of Thoracic Surgeons/American College of Cardiology (STS/ACC) Transcatheter Valve Therapy (TVT) registry to examine how institutional experience relates to procedural results of transcatheter mitral valve repair (TMVR) was published by Adnan K. Chhatriwalla, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2019;12:1342–1352).
For the study, TMVR procedures with the MitraClip device (Abbott Structural Heart) in the STS/ACC TVT registry were stratified into tertiles on the basis of site-specific case sequence (1–18; 19–51; and 52–482). MitraClip procedures (n = 12,334) performed at 275 sites between November 2013 and September 2017 were analyzed. The investigators examined in-hospital outcomes of procedural success, time, and complications. They developed generalized linear mixed models using case sequence number as a continuous variable to evaluate the learning curve for the procedure.
As summarized in JACC: Cardiovascular Interventions, the investigators reported:
- Optimal procedural success (≤ 1+ residual MR without mortality or need for cardiac surgery) increased across tertiles of case experience (62%, 65.5%, and 72.5%; P < .001), whereas procedural time and procedural complications decreased.
- Acceptable procedural success (≤ 2+ residual MR without death or need for cardiac surgery) also increased across tertiles of case experience, but the differences were smaller (91.2%, 91.2%, and 92.9%; P = .006).
In the learning curve analysis, the investigators found that visual inflection points for procedural time, success, and complications were evident after approximately 50 cases, with continued improvements observed up to 200 cases.
For TMVR with the MitraClip, increasing institutional experience was associated with improvements in procedural success, time, and complications; additionally, the impact of institutional experience was larger when considering the goal of achieving optimal MR reduction, concluded the investigators in JACC: Cardiovascular Interventions.