Analysis: Operator Experience, Higher Case Volume Yield Better Outcomes

Robust operator experience and a higher volume of transcatheter aortic valve replacement (TAVR) procedures were both associated with better patient safety and more favorable outcomes, new research suggests.  

Study researchers used data from 16 centers participating in the international TAVR registry, and divided cases into five categories of operator experience (initial, 1 to 75 cases; early,76 to 150 cases; intermediate, 151 to 225 cases; high, 226 to 300 cases; very high, >300 cases) for learning curve characterization. They also stratified annual TAVR case volume into low- (<50), moderate- (50 to 100), and high-volume (>100) groups and collected procedural and 30-day clinical outcomes data. The analysis included 3,403 patients.  

TAVR performed at low annual volume (<50 procedures) institutions associated with higher mortality. Learn more in #JACCINT: https://t.co/04PXly6x7C. pic.twitter.com/6nPktKApH9

— JACC Journals (@JACCJournals) September 18, 2018

According to the results, all-cause mortality was higher for the first three categories of operator experience (early, low, intermediate) compared to high- and very high-experienced operators. The safety endpoint was worst in all groups except for very high-experience operators. The researchers also reported that low annual TAVR procedure volume (<50 cases) was associated with significantly higher all-cause 30-day mortality (OR=2.70; 95% CI, 1.44 to 5.07) and a worse safety endpoint as well (OR=1.60; 95% CI, 1.17 to 2.17). 

“Transcatheter aortic valve replacement procedures display important learning curve characteristics with both greater procedural safety and a lower mortality when performed by experienced operators,” the researchers concluded. “In addition, TAVR performed at low annual volume institutions is associated with decreased procedural safety and higher patient mortality. These findings have important implications for operator training and patient care at centers performing TAVR.” 

NOT every hospital should have TAVR program! ⁦@BBHHeart1⁩ ⁦@MustafaAhmedMD⁩ ⁦@KyleEudaileyMD⁩ ⁦@mmamas1973⁩ ⁦@willsuh76⁩ ⁦@mirvatalasnag⁩ ⁦@SVRaoMD⁩ ⁦@DrChuckSimonton⁩ https://t.co/P8TLjFzvQM

— Alain Bouchard (@AlainBouchardmd) September 4, 2018

TAVI performed at low annual volume (<50 procedures) institutions is associated with decreased procedural safety and higher patient mortality. https://t.co/5KHuPRheH1

— Rafa Sádaba (@rafasadaba) September 4, 2018

TAVR procedures-greater procedural safety & lower mortality when performed by experienced operators.
TAVR performed at low annual volume(<50 procedures) institutions is associated with decreased procedural safety & higher patient mortality.

https://t.co/7CW1Kitmn4

— LeeB (@Faithgirlee) September 7, 2018

Did industry not think to have everyone doing TAVI regardless of the volume? https://t.co/gObyQHNJVS

— Domenico Pagano (@dompagano) September 4, 2018

Source: JACC Interventions