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Operator Experience and Outcomes of Transcatheter Mitral Valve Repair in the United States

Transcatheter mitral valve repair (TMVr) for the treatment of mitral regurgitation (MR) is a complex procedure that requires development of a unique skillset. The purpose of this study was to examine the relationship between operator experience and procedural results of TMVr. TMVr device procedures...

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Published in:Journal of the American College of Cardiology 2019-12, Vol.74 (24), p.2955-2965
Main Authors: Chhatriwalla, Adnan K., Vemulapalli, Sreekanth, Szerlip, Molly, Kodali, Susheel, Hahn, Rebecca T., Saxon, John T., Mack, Michael J., Ailawadi, Gorav, Rymer, Jennifer, Manandhar, Pratik, Kosinski, Andrzej S., Sorajja, Paul
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creator Chhatriwalla, Adnan K.
Vemulapalli, Sreekanth
Szerlip, Molly
Kodali, Susheel
Hahn, Rebecca T.
Saxon, John T.
Mack, Michael J.
Ailawadi, Gorav
Rymer, Jennifer
Manandhar, Pratik
Kosinski, Andrzej S.
Sorajja, Paul
description Transcatheter mitral valve repair (TMVr) for the treatment of mitral regurgitation (MR) is a complex procedure that requires development of a unique skillset. The purpose of this study was to examine the relationship between operator experience and procedural results of TMVr. TMVr device procedures from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry were analyzed with operator case number as a continuous and categorical (1 to 25, 26 to 50, and >50) variable. Outcomes of procedural success, procedural time, and in-hospital procedural complications were examined. The learning curve for the procedure was evaluated using generalized linear mixed models adjusting for baseline clinical variables. All TMVr device procedures (n = 14,923) performed by 562 operators at 290 sites between November 2013 and March 2018 were analyzed. Optimal procedural success (≤1+ residual MR without death or cardiac surgery) increased across categories of operator experience (63.9%, 68.4%, and 75.1%; p 
doi_str_mv 10.1016/j.jacc.2019.09.014
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Acceptable procedural success (≤2+ residual MR without death or cardiac surgery) also increased with operator experience, but the differences were smaller (91.4%, 92.4%, and 93.8%; p &lt; 0.001). These associations remained significant in adjusted, continuous variable analyses. Visual inflection points in the learning curves for procedural time, procedural success, and procedural complications were evident after approximately 50 cases, with continued improvements observed out to 200 cases. For TMVr device procedures, operator experience was associated with improvements in procedural success, procedure time, and procedural complications. The effect of operator experience was greater when considering the goal of achieving 1+ residual MR. 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Acceptable procedural success (≤2+ residual MR without death or cardiac surgery) also increased with operator experience, but the differences were smaller (91.4%, 92.4%, and 93.8%; p &lt; 0.001). These associations remained significant in adjusted, continuous variable analyses. Visual inflection points in the learning curves for procedural time, procedural success, and procedural complications were evident after approximately 50 cases, with continued improvements observed out to 200 cases. For TMVr device procedures, operator experience was associated with improvements in procedural success, procedure time, and procedural complications. The effect of operator experience was greater when considering the goal of achieving 1+ residual MR. 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subjects Aged
Aged, 80 and over
Cardiac Surgical Procedures - adverse effects
Cardiac Surgical Procedures - instrumentation
Cardiac Surgical Procedures - statistics & numerical data
Cardiology
Clinical outcomes
Complications
Continuity (mathematics)
Endovascular Procedures - adverse effects
Endovascular Procedures - instrumentation
Endovascular Procedures - statistics & numerical data
Female
Heart
Heart surgery
Heart valves
Humans
Inflection points
Learning Curve
Learning curves
Male
mitral regurgitation
Mitral valve
Mitral Valve - surgery
Mitral Valve Insufficiency - surgery
Mortality
operator
Patients
Registries
Regurgitation
Repair
Statistical models
Success
Surgery
Thorax
Thrombosis
TMVr
Treatment Outcome
United States
Variables
Vascular surgery
title Operator Experience and Outcomes of Transcatheter Mitral Valve Repair in the United States
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