title: Impact of the learning curve on outcome after transcatheter mitral valve repair: results from the German Mitral Valve Registry.
abstract: OBJECTIVE
  This analysis from the German Mitral Valve Registry investigates the impact of the learning curve with the MitraClip(®) technique on procedural success and complications.
  
  
  RESULTS
  Consecutive patients treated since 2009 in centers that performed more than 50 transcatheter mitral repairs were included. Results of the first half of the patients were compared to those of the second. Altogether 496 patients from 10 centers were included. Patients treated later had less common severe heart failure symptoms (patients with NYHA IV: 22.1 vs. 14.5 %, p < 0.05). The EuroSCORE I (22.0 vs. 23.0 %, p = ns) and Society of Thoracic Surgeons (STS) score (7.5 vs. 9.5 %, p = ns) did not differ between both groups. Procedural success was 95.6 % (238/249) in the first cases and 94.7 % (232/245, p = ns) subsequently. Also procedural time (104.3 vs. 119 min, p = ns) and complications did not decrease over time.
  
  
  CONCLUSIONS
  A learning curve using the MitraClip(®) device does not appear to significantly affect acute MR reduction, hospital and 30-day mortality. Most likely, the proctor system leads to already high initial procedure success and relatively short procedure time.
authors.affiliation: CardioVascular Center Frankfurt, Frankfurt, Germany, jakobledwoch@yahoo.de.
authors.forename: Jakob
authors.initials: J
authors.lastname: Ledwoch
authors.forename: Jennifer
authors.initials: J
authors.lastname: Franke
authors.forename: Stephan
authors.initials: S
authors.lastname: Baldus
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schillinger
authors.forename: Raffi
authors.initials: R
authors.lastname: Bekeredjian
authors.forename: Peter
authors.initials: P
authors.lastname: Boekstegers
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hink
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Kuck
authors.forename: Taoufik
authors.initials: T
authors.lastname: Ouarrak
authors.forename: Helge
authors.initials: H
authors.lastname: Möllmann
authors.forename: Georg
authors.initials: G
authors.lastname: Nickenig
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
authors.forename: Olaf
authors.initials: O
authors.lastname: Franzen
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D017052:Hospital Mortality; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D016896:Treatment Outcome