Arash Salemi1, Art Sedrakyan2, Jialin Mao2, Adham Elmously1, Harindra Wijeysundera3, Derrick Y Tam3, Antonino Di Franco1, Simon Redwood4, Leonard N Girardi1, Stephen E Fremes3, Mario Gaudino5. 1. Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. 2. Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York. 3. Schulich Heart Centre, Sunnybrook Health Science, University of Toronto, Toronto, Ontario, Canada. 4. BHF Centre of Excellence, Cardiovascular Department, King's College St. Thomas' Hospital, London, United Kingdom. 5. Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York. Electronic address: mfg9004@med.cornell.edu.
Abstract
OBJECTIVES: The aim of this study was to assess the impact of individual operator experience on transfemoral transcatheter aortic valve replacement (TAVR) outcomes. BACKGROUND: TAVR volume-outcome relationships have not been evaluated at the individual operator level. METHODS: New York Statewide Planning and Research Cooperative System data from 8,771 transfemoral TAVR procedures performed by 207 operators between 2012 and 2016 were analyzed. Operator volume was defined as the number of TAVR procedures performed during 1 year prior to 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. RESULTS: After adjusting for hospital and physician characteristics, patients undergoing TAVR performed by high-volume physicians (≥80/year) had a significantly lower risk for death, stroke, or acute myocardial infarction (odds ratio: 0.59; 95% confidence interval: 0.37 to 0.93) compared with those treated by low-volume physicians (<24/year). Being treated by operators who performed 200 procedures during the prior year was associated with significantly lower risks for post-procedural stroke (odds ratio: 0.41; 95% confidence interval: 0.17 to 0.97) and composite events (odds ratio: 0.45; 95% confidence interval: 0.26 to 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. CONCLUSIONS: Increased TAVR experience of operators is associated with improved risk-adjusted in-hospital outcomes. These results have potentially important implications for individual training and hospital programs in TAVR.
OBJECTIVES: The aim of this study was to assess the impact of individual operator experience on transfemoral transcatheter aortic valve replacement (TAVR) outcomes. BACKGROUND: TAVR volume-outcome relationships have not been evaluated at the individual operator level. METHODS: New York Statewide Planning and Research Cooperative System data from 8,771 transfemoral TAVR procedures performed by 207 operators between 2012 and 2016 were analyzed. Operator volume was defined as the number of TAVR procedures performed during 1 year prior to 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. RESULTS: After adjusting for hospital and physician characteristics, patients undergoing TAVR performed by high-volume physicians (≥80/year) had a significantly lower risk for death, stroke, or acute myocardial infarction (odds ratio: 0.59; 95% confidence interval: 0.37 to 0.93) compared with those treated by low-volume physicians (<24/year). Being treated by operators who performed 200 procedures during the prior year was associated with significantly lower risks for post-procedural stroke (odds ratio: 0.41; 95% confidence interval: 0.17 to 0.97) and composite events (odds ratio: 0.45; 95% confidence interval: 0.26 to 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. CONCLUSIONS: Increased TAVR experience of operators is associated with improved risk-adjusted in-hospital outcomes. These results have potentially important implications for individual training and hospital programs in TAVR.
Authors: Christian Frerker; Tobias Schmidt; Max M Meertens; Sascha Macherey; Sebastiaan Asselberghs; Samuel Lee; Jan Hendrik Schipper; Barend Mees; Ingo Eitel; Stephan Baldus Journal: Clin Res Cardiol Date: 2022-03-17 Impact factor: 6.138
Authors: Caitlin B Finn; Jason K Tong; Hannah E Alexander; Chris Wirtalla; Heather Wachtel; Carmen E Guerra; Shivan J Mehta; Richard Wender; Rachel R Kelz Journal: J Gen Intern Med Date: 2022-04-19 Impact factor: 6.473
Authors: Kerstin Piayda; Katharina Hellhammer; Jens Erik Nielsen-Kudsk; Boris Schmidt; Patrizio Mazzone; Sergio Berti; Sven Fischer; Juha Lund; Matteo Montorfano; Paolo Della Bella; Ryan Gage; Tobias Zeus Journal: BMJ Open Date: 2021-03-24 Impact factor: 2.692