Key result
Sapien TAVI proficiency requires ~43 cases to reduce procedure times, contrast, and radiation exposure.
Why the study?
The study investigated the association between surgical team maturity and outcome using TAVI procedure time.
Does surgical team proficiency (experience of >43 cases) improve procedural outcomes and reduce procedure time in patients undergoing transfemoral TAVI?
Cohort (n=99)
No
Does surgical team proficiency (experience of >43 cases) improve procedural outcomes and reduce procedure time in patients undergoing transfemoral TAVI?
A surgical team requires approximately 43 cases to reach proficiency in transfemoral TAVI, which is associated with improved procedural metrics and may serve as a benchmark for transitioning to local anesthesia.
Answers are grounded in this paper and cite their sources.
Proficiency after ~43 cases was associated with shorter procedures and less contrast/radiation; supports training benchmarks but leaves outcome impact open.
Background We used transcatheter aortic valve implantation (TAVI) procedure time to investigate the association between surgical team maturity and outcome. Methods 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. Results Ninety-nine of 149 patients were analysed. The sigmoid curve had an inflection point in 34.7 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. Conclusion The number of cases required for surgeon proficiency in TAVI was approximately 43. This number may serve as a guideline for switching the anesthesia management of TAVI from general to local anesthesia.
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Miyoshi et al. (2023) conducted a cohort in Severe aortic stenosis (n=99). Late group (after reaching learning curve plateau) vs. Early group (before reaching learning curve plateau) was evaluated on Number of cases to reach a plateau in TAVI procedure time (p=<0.0001). The number of cases required for surgeon proficiency in TAVI using the Sapien valve was approximately 43, after which procedure times, contrast media, and radiation exposure decreased.
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