title: The Learning Curve for Transcatheter Mitral Valve Repair With MitraClip.
abstract: OBJECTIVE
  This study sought to assess the learning curve for TMVR for treatment of primary mitral regurgitation (MR).
  
  
  BACKGROUND
  Data are lacking regarding the technical experience required to achieve optimal clinical outcomes with transcatheter mitral valve repair (TMVR) using the edge-to-edge MitraClip technique.
  
  
  METHODS
  We examined the sequential experience of the first 75 patients (age 80 ± 9 years; 77% male) who underwent TMVR at our institution. A sequence number of each patient was assigned as a continuous variable and in tertiles for analysis.
  
  
  RESULTS
  TMVR with MitraClip was successful in 97% with an average procedural time of 106 ± 39 minutes. The 30-day rate of major adverse cardiovascular events was 7%. With increased case experience, there were decreases in procedural time, fluoroscopy time, length of hospital stay, and major adverse cardiovascular events. Procedural success, residual mitral regurgitation and NYHA functional classification at 30-day follow-up remained unchanged throughout the experience.
  
  
  CONCLUSIONS
  The learning curve for TMVR with MitraClip for treatment of primary MR is characterized by a sequential reduction in procedure time, fluoroscopy time, procedural complications, and hospital length of stay at a tertiary academic medical center. Thirty-day procedural results are favorable and similar during the initial learning period.
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Minnesota. eleid.mackram@mayo.edu.
authors.forename: Mackram F
authors.initials: MF
authors.lastname: Eleid
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Minnesota.
authors.forename: Guy S
authors.initials: GS
authors.lastname: Reeder
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Minnesota.
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Malouf
authors.affiliation: Department of Biostatistics, Mayo Clinic, Minnesota.
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Lennon
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Minnesota.
authors.forename: Sorin V
authors.initials: SV
authors.lastname: Pislaru
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Minnesota.
authors.forename: Vuyisille T
authors.initials: VT
authors.lastname: Nkomo
authors.affiliation: Department of Cardiovascular Diseases, Mayo Clinic, Minnesota.
authors.forename: Charanjit S
authors.initials: CS
authors.lastname: Rihal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D005260:Female; D005471:Fluoroscopy / Q000379:methods; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D059032:Learning Curve; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D061646:Operative Time; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology*; D014481:United States