Institutional Experience With Transcatheter Mitral Valve Repair and Clinical Outcomes: Insights From the TVT Registry.
OBJECTIVES
The aim of this study was to examine the relation between institutional experience and procedural results of transcatheter mitral valve repair.


BACKGROUND
Transcatheter mitral valve repair for the treatment of mitral regurgitation (MR) is a complex procedure requiring navigation of the left atrium, left ventricle, and mitral valve apparatus using echocardiographic guidance.


METHODS
MitraClip procedures from the Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry were stratified into tertiles on the basis of site-specific case sequence (1 to 18, 19 to 51, and 52 to 482). In-hospital outcomes of procedural success, procedural time, and procedural complications were examined. To evaluate the learning curve for the procedure, generalized linear mixed models were developed using case sequence number as a continuous variable.


RESULTS
MitraClip procedures (n = 12,334) performed at 275 sites between November 2013 and September 2017 were analyzed. Optimal procedural success (≤1+ residual MR without mortality or need for cardiac surgery) increased across tertiles of case experience (62.0%, 65.5%, and 72.5%; p < 0.001), whereas procedural time and procedural complications decreased. Acceptable procedural success (≤2+ residual MR without death or need for cardiac surgery) also increased across tertiles of case experience, but the differences were smaller (91.2%, 91.2%; and 92.9%; p = 0.006). In the learning-curve analysis, visual inflection points for procedural time, procedural success, and procedural complications were evident after about 50 cases, with continued improvements observed up to 200 cases.


CONCLUSIONS
For transcatheter mitral valve repair with the MitraClip, increasing institutional experience was associated with improvements in procedural success, procedure time, and procedural complications. The impact of institutional experience was larger when considering the goal of achieving optimal MR reduction.
['Chhatriwalla|Adnan K|AK|', 'Vemulapalli|Sreekanth|S|', 'Holmes|David R|DR|', 'Dai|Dadi|D|', 'Li|Zhuokai|Z|', 'Ailawadi|Gorav|G|', 'Glower|Donald|D|', 'Kar|Saibal|S|', 'Mack|Michael J|MJ|', 'Rymer|Jennifer|J|', 'Kosinski|Andrzej S|AS|', 'Sorajja|Paul|P|']
D000368:Aged D000369:Aged, 80 and over D006328:Cardiac Catheterization D002983:Clinical Competence D005260:Female D006350:Heart Valve Prosthesis D019918:Heart Valve Prosthesis Implantation D006801:Humans D059032:Learning Curve D008297:Male D008943:Mitral Valve D008944:Mitral Valve Insufficiency D061646:Operative Time D011183:Postoperative Complications D012042:Registries D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D013997:Time Factors D016896:Treatment Outcome D016526:Workload
institution mitral regurgitation MitraClip learning curve TMVr