Author + information
- Received February 5, 2019
- Accepted February 26, 2019
- Published online July 15, 2019.
- Adnan K. Chhatriwalla, MDa,∗ (, )@akcmahi,
- Sreekanth Vemulapalli, MDb,
- David R. Holmes Jr., MDc,
- Dadi Dai, PhDb,
- Zhuokai Li, PhDb,
- Gorav Ailawadi, MDd,
- Donald Glower, MDb,
- Saibal Kar, MDe,
- Michael J. Mack, MDf,
- Jennifer Rymer, MDb,
- Andrzej S. Kosinski, PhDb and
- Paul Sorajja, MDg
- aSaint Luke’s Mid America Heart Institute, University of Missouri–Kansas City, Kansas City, Missouri
- bDuke University and Duke Clinical Research Institute, Durham, North Carolina
- cMayo Clinic, Rochester, Minnesota
- dUniversity of Virginia, Charlottesville, Virginia
- eCedars Sinai Hospital, Los Angeles, California
- fBaylor Scott & White Health, Dallas, Texas
- gValve Science Center, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, Minnesota
- ↵∗Address for correspondence:
Dr. Adnan K. Chhatriwalla, Saint Luke’s Mid America Heart Institute, 4330 Wornall Road, Suite 2000, Kansas City, Missouri 64111.
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.
Dr. Chhatriwalla is a proctor for Edwards Lifesciences and Medtronic; and is a member of the Speakers Bureaus of Abbott Vascular, Edwards Lifesciences, and Medtronic. Dr. Vemulapalli has received grants from Abbott Vascular, Boston Scientific, the American College of Cardiology, the Society of Thoracic Surgeons, and the Patient-Centered Outcomes Research Institute; and serves as a consultant to Boston Scientific, Premiere, Janssen, and Zafgen. Dr. Ailawadi is a consultant for Abbott Vascular, Atricure, Edwards Lifesciences, Medtronic, and St. Jude Medical. Dr. Kar has received honoraria from Abbott Vascular, Boston Scientific, Medtronic, and W.L. Gore and research grants from Medtronic. Dr. Mack has received research grants from Abbott Vascular, Edwards Lifesciences, and Medtronic. Dr. Rymer has received research support from the American College of Cardiology. Dr. Sorajja is a consultant for Abbott Vascular, Admedus, Boston Scientific, Edwards Lifesciences, W.L. Gore, Medtronic, and Teleflex; has received research grants from Abbott Vascular, Boston Scientific, Edwards Lifesciences, and Medtronic; and he is on advisory boards for Abbott and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received February 5, 2019.
- Accepted February 26, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.