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.
Minimally Invasive Parasternal Aortic Valve Replacement: A Slow Learning Curve toward Improved Outcomes
