Operator experience is a key factor in successfully obtaining better procedural outcomes when performing transcatheter mitral valve repair for the treatment of mitral regurgitation. The findings from an analysis of data from the STS/ACC TVT Registry were presented Sept. 27 at TCT 2019 and simultaneously published in the Journal of the American College of Cardiology.

Transcatheter mitral valve repair using a MitraClip device has been performed in the U.S. since 2013 but is a complex and still relatively novel procedure. Adnan K. Chhatriwalla, MD, FACC, et al., reviewed data from 14,923 transcatheter mitral valve repair cases enrolled in the STS/ACC TVT Registry from November 2013 to March 2018. The cases were performed by 562 operators at 290 U.S. sites. Patient baseline characteristics were comparable for all three categories.

Of the 562 operators, 549 performed 1-25 cases, 230 performed 26-50 cases and 116 performed more than 50 cases during the study period. Researchers found that procedural success improved across categories of operator experience while procedural time and complications decreased.

Optimal success, defined as ≤1+ residual mitral regurgitation without death or cardiac surgery, increased across the categories of operator experience (63.9 percent, 68.4 percent and 75.1 percent; p<0.001). Likewise, there was an increase for acceptable procedural success, defined as residual ≤2+ mitral regurgitation without death or cardiac surgery, with more operator experience (91.4 percent, 92.4 percent, and 93.8 percent, p<0.001).

Regarding the learning curve, at about 50 cases there was an evident improvement, with continuous improvement up to 200 cases.

"Increasing operator case experience was associated with improvements in procedural outcomes, including procedural success, procedure time and procedural complications," concluded the researchers. "These findings suggest that a relatively greater attention to case selection may be important during the early operator experience. Further research is needed to understand the specific factors associated with operator and site experience that impact long-term clinical outcomes."

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Aortic Surgery, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: TCT19, Transcatheter Cardiovascular Therapeutics, Registries, Transcatheter Aortic Valve Replacement, Angiography, Percutaneous Coronary Intervention, National Cardiovascular Data Registries, STS/ACC TVT Registry

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