title: Learning Curve Assessment for Percutaneous Left Atrial Appendage Closure With the WATCHMAN Occluder.
abstract: OBJECTIVE
  We sought to evaluate the effect of increasing experience with left atrial appendage (LAA) closure on short-term outcome.
  
  
  BACKGROUND
  Data regarding the impact of the learning curve of LAA closure-particularly regarding technical aspects of the procedure-are lacking.
  
  
  METHODS
  The present analysis represents first data from a single-center all-comer registry. The population was divided into 3 groups according to treatment time (group 1: patients 1-30; group 2: patients 31-60; group 3: patients 61-90).
  
  
  RESULTS
  The mean age of the population was 77 years. Median CHA2 DS2 VASC Score and HAS-BLED were 5 (IQR 3-5) and 3 (IQR 3-4), respectively. Implantation success was 90% with a slight but not statistically significant increase during the course of the registry. Procedure time (75 [62-108] vs. 50 [43-66] vs. 47 [41-61] minutes; P < 0.0001), fluoroscopy time (20 [15-30] vs. 11 [8-19] vs. 11 [9-18] minutes; P = 0.002), and contrast volume (105 [70-170] vs. 60 [50-75] vs. 50 [50-73] ml; P < 0.0001) were reduced across the 3 groups. In-hospital complications decreased significantly (20 vs. 7% vs. 0%; P = 0.021). The compression grade of the occluder was chosen higher with increasing learning curve (15 [11-25] vs. 25 [17-29] vs. 21 [14-26] %; P = 0.05).
  
  
  CONCLUSIONS
  With increasing operator experience the performance and safety of percutaneous LAA closure improved continuously.
authors.affiliation: Städtisches Klinikum München GmbH, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Munich, Germany.
authors.forename: Jakob
authors.initials: J
authors.lastname: Ledwoch
authors.affiliation: Städtisches Klinikum München GmbH, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Munich, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Krollmann
authors.affiliation: Städtisches Klinikum München GmbH, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Munich, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Staubach
authors.affiliation: Städtisches Klinikum München GmbH, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Hug
authors.affiliation: Städtisches Klinikum München GmbH, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Munich, Germany.
authors.forename: Henning
authors.initials: H
authors.lastname: Strohm
authors.affiliation: Städtisches Klinikum München GmbH, Klinik für Kardiologie, Pneumologie und Internistische Intensivmedizin, Klinikum Neuperlach, Munich, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Mudra
mesh_terms: D000368:Aged; D020517:Atrial Appendage / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005858:Germany; D006801:Humans; D059032:Learning Curve; D008297:Male; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D012042:Registries; D017751:Safety Management / Q000379:methods; D055989:Septal Occluder Device; D016896:Treatment Outcome