title: Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement.
abstract: Objectives.To evaluate whether collaboration between existing and new transcatheter aortic valve replacement (TAVR) programs could help reduce the number of cases needed to achieve optimal efficiency.Background.There is a well-documented learning curve for achieving procedural efficiency and safety in TAVR procedures.Methods.A multidisciplinary collaboration was established between the Minneapolis VA Medical Center (new program) and the University of Minnesota (established program since 2012,n= 219) 1 year prior to launching the new program.Results.269 patients treated with TAVR (50 treated in the first year at the new program). Mean age was 76 (±18) years and STS score was 6.8 (±6). Access included transfemoral (n= 35, 70%), transapical (n= 8, 16%), transaortic (n= 2, 4%), and subclavian (n= 5, 10%) types. Procedural efficiency (procedural time 158 ± 59 versus 148 ± 62,p= 0.27), device success (96% versus 87%,p= 0.08), length of stay (5 ± 3 versus 6 ± 7 days,p= 0.10), and safety (in hospital mortality 4% versus 6%,p= 0.75) were similar between programs. We found no difference in outcome measures between the first and last 25 patients treated during the first year of the new program.Conclusions.Establishing a partnership with an established program can help mitigate the learning curve associated with these complex procedures.
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Sergey
authors.identifier: 0000-0002-1808-915X
authors.initials: S
authors.lastname: Gurevich
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Rosemary F
authors.initials: RF
authors.lastname: Kelly
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Ganesh
authors.identifier: 0000-0002-6030-9232
authors.initials: G
authors.lastname: Raveendran
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Helmer
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Demetris
authors.initials: D
authors.lastname: Yannopoulos
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Timinder
authors.initials: T
authors.lastname: Biring
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Oestreich
authors.affiliation: University of Minnesota-Fairview Medical Center, Minneapolis, MN, USA; Minneapolis VA Healthcare System, Minneapolis, MN, USA.
authors.forename: Santiago
authors.identifier: 0000-0002-1806-6783
authors.initials: S
authors.lastname: Garcia