Impact of proficiency in the transcatheter aortic valve implantation procedure on clinical outcomes: a single center retrospective study

TL;DR

This study finds that surgeons become more proficient at a heart valve implantation procedure after performing about 43 cases, leading to better clinical outcomes.

Contribution

The study identifies a specific number of cases (43) required for surgeon proficiency in TAVI, which could influence anesthesia management strategies.

Findings

Surgeons reached proficiency after 43 TAVI cases, marked by shorter procedure times and reduced resource use.

Late group patients had shorter operating times, less contrast media, less radiation exposure, and lower myocardial escape enzymes.

Procedure time correlated most strongly with the number of surgeries performed.

Abstract

We used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome.

Among patients who underwent TAVI between October 2015 and November 2019, those who had Sapien™ implanted with the transfemoral artery approach were included in the analysis. We used TAVI procedure time and surgery number to draw a learning curve. Then, we divided the patients into two groups before and after the number of cases where the sigmoid curve reaches a plateau. We compared the two groups regarding the surveyed factors and investigated the correlation between the TAVI procedure time and survey factors.

Ninety-nine of 149 patients were analysed. The sigmoid curve had an inflection point in 23.2 cases and reached a plateau in 43.0 cases. Patients in the Late group had a shorter operating time, less contrast media, less radiation exposure, and less myocardial escape enzymes than the Early group. Surgical procedure time showed the strongest correlation with the surgical case number.

The number of cases required for surgeon proficiency for isolated Sapien™ valve implantation was 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.

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