Study Shows Impact of Operator Experience and Procedural Results of TMVR in the STS/ACC TVT Registry

September 27, 2019—In Journal of the American College of Cardiology (JACC), Adnan K. Chhatriwalla, MD, published findings from an examination of the relationship between operator experience and procedural results of transcatheter mitral valve repair (TMVR) with the MitraClip device (Abbott). Dr. Chhatriwalla presented the findings at TCT 2019, the 31st annual Transcatheter Cardiovascular Therapeutics scientific symposium held September 25–29 in San Francisco, California.

The study analyzed TMVR procedures from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry (STS/ACC TVT Registry) were analyzed with operator case number as a continuous and categorical (1–25, 26–50, and > 50) variable. Investigators examined outcomes of procedural success, procedural time, and in-hospital procedural complications. The learning curve for the procedure was evaluated using generalized linear mixed models adjusting for baseline clinical variables.

As summarized in JACC, the analysis included all TMVR device procedures (n = 14,923) performed by 562 operators at 290 sites between November 2013 and March 2018 in the STS/ACC TVT Registry. The investigators reported the following:

• Optimal procedural success (≤ 1+ residual MR without death or cardiac surgery) increased across categories of operator experience (63.9%, 68.4%, and 75.1%; P < .001), and procedural time and procedural complications decreased.
• Acceptable procedural success (≤ 2+ residual MR without death or cardiac surgery) also increased with operator experience, but the differences were smaller (91.4%, 92.4%, and 93.8%; P < .001).
• Visual inflection points in the learning curves for procedural time, procedural success, and procedural complications were evident after approximately 50 cases, with continued improvements observed up to 200 cases.

The investigators concluded that operator experience was associated with improvements in procedural success, procedure time, and procedural complications for TMVR device procedures. The impact of operator experience was greater when considering the goal of achieving 1+ residual MR, noted the investigators in JACC.