title: The impact of live case transmission on patient outcomes during transcatheter aortic valve replacement: results from the VERITAS study.
abstract: BACKGROUND
  Live case demonstration as an educational tool is widely used to rapidly and effectively disseminate information on surgical and interventional techniques. The risks and benefits of live case transmission for investigational devices, however, are in question.
  
  
  METHODS
  Transcatheter Aortic Valve Intervention-Live Transmission (VERITAS) is a case-control study of 60 patients from 5 centers who were treated with transcatheter aortic valve replacement (TAVR) during live- or recorded transmission; of which 42 have matched Control subjects from five sites. Case and Control subjects were matched by valve type, access strategy (Edwards SAPIEN transfemoral, Edwards SAPIEN transapical, CoreValve transfemoral), Society of Thoracic Surgeons (STS) score, date of TAVR procedure, and primary operator.
  
  
  RESULTS
  The Case and Control groups' baseline characteristics were similar, with average ages of 84 and 82 years, and STS scores of 6.54±3.22 and 6.46±3.20, respectively. The number of operators, fluoroscopy time, contrast volume and length of hospital stay were also similar between groups. Overall, 91.7% of the cases had TAVR via a transfemoral approach; 72% of these patients received a closure device. The final valve position was adequate in 91.2% of the Case patients and in 97% of the Control patients, with no cases of valve migration or coronary obstruction. The Case patients had longer procedure times (130.2±50.6 versus 100.6±43.7min; p=0.006). The Valve Academic Research Consortium in-hospital complications were similar between groups. Four Case patients and 1 Control patient required additional valve implantation.
  
  
  CONCLUSIONS
  Data support the notion that live transmission of TAVR procedures, when performed by experienced operators, can be done safely with similar outcomes when compared to non-transmitted cases.
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA. Electronic address: ron.waksman@medstar.net.
authors.forename: Ron
authors.initials: R
authors.lastname: Waksman
authors.affiliation: Guys and St. Thomas' Hospital, London, United Kingdom.
authors.forename: Martyn
authors.initials: M
authors.lastname: Thomas
authors.affiliation: Bern University Hospital, Bern, Switzerland.
authors.forename: Steffen
authors.initials: S
authors.lastname: Gloekler
authors.affiliation: CardioVasculares Centrum Frankfurt, Frankfurt, Germany.
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.affiliation: Saint Paul's Hospital, Vancouver, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Webb
authors.affiliation: CardioVasculares Centrum Frankfurt, Frankfurt, Germany.
authors.forename: Nina
authors.initials: N
authors.lastname: Staiger
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Torguson
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Kaneshige
authors.affiliation: MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Aly
authors.affiliation: San Raffaele Hospital, Milan, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D002170:Canada; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation; D003194:Computer-Assisted Instruction; D004501:Education, Medical / Q000379:methods*; D005060:Europe; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D007902:Length of Stay; D008297:Male; D061214:Patient Safety; D011474:Prosthesis Design; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D014481:United States; D014741:Video Recording
keywords: Society of Thoracic Surgeons; Transcatheter aortic valve replacement; Valve