Operator Experience Matters for Transcatheter Mitral Valve Repair

December 30, 2019 by Dr. Clemens Leave a Comment

Authors: Chhatriwalla AK et al.

J Am Coll Cardiol 2019 Dec 17 Resor CD. J Am Coll Cardiol 2019 Dec 17

A registry analysis demonstrated an improvement in procedure success after an interventionalist’s first 50 cases.

Transcatheter mitral valve repair (TMVr) with MitraClip was FDA-approved in 2013. To assess the association between operator experience and procedural outcomes, investigators analyzed the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy (TVT) Registry involving 14,923 commercial procedures performed by 562 operators at 290 U.S. hospitals between 2013 and 2018.

The study population had a median age of 81 and a high prevalence of comorbid conditions. In stepwise fashion across levels of operator experience (1–25 cases, 26–50 cases, and >50 cases), there were decreases in procedure time (145, 118, and 99 minutes, respectively) and complications (10%, 8%, and 7%) and greater optimal procedural success (64%, 68%, and 75%; optimal success was defined as residual mitral regurgitation (MR) at a grade of 1 or less and no mortality or requirement for cardiac surgery). In adjusted analyses of number of cases as a continuous variable, an inflection point in the learning curve for procedural success was visible after 50 cases, with improvement continuing to 200 cases.

COMMENT

TMVr is a complex, multidisciplinary procedure that is generally safe and effective. In this observational analysis of all U.S. commercial cases, optimal outcomes were related to operator experience with evidence for a learning curve that is most prominent or evident for the first 50 cases. These data should help to inform standards for operators and institutions.

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