Impact of Operator Characteristics on Outcomes in Transcatheter Aortic Valve Replacement.
Aged, 80 and over
Aortic Valve
/ surgery
Aortic Valve Stenosis
/ diagnosis
Female
Follow-Up Studies
Hospital Mortality
/ trends
Humans
Male
Registries
Retrospective Studies
Risk Assessment
/ methods
Risk Factors
Survival Rate
/ trends
Time Factors
Transcatheter Aortic Valve Replacement
/ methods
Treatment Outcome
United States
/ epidemiology
Journal
The Annals of thoracic surgery
ISSN: 1552-6259
Titre abrégé: Ann Thorac Surg
Pays: Netherlands
ID NLM: 15030100R
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
11
03
2020
revised:
24
04
2020
accepted:
01
06
2020
pubmed:
17
8
2020
medline:
10
3
2021
entrez:
16
8
2020
Statut:
ppublish
Résumé
Operator characteristics and outcome relationships have not been evaluated at the individual operator level. From New York State Department of Health Statewide Planning and Research Cooperative System, 5896 elective transfemoral transcatheter aortic valve replacement (TAVR) procedures performed by 161 operators between 2012 and 2016 were analyzed. We examined the following characteristics of the primary operator: specialty (surgery vs cardiology), sex, medical school location, experience of cardiology practice, interventional cardiology credentialing, past-year TAVR volume, and first year performing TAVR in New York State. The primary outcome was a composite of inhospital mortality, stroke, and acute myocardial infarction. After adjusting for patient and other provider characteristics, there was no significant difference in the risk of major events between surgeons and cardiologists in performing TAVR (3.4% vs 3.6%, P = .60), between male operators and female operators (P = .80), and between operators who graduated from a US medical school and operators educated outside the United States (3.4% vs 3.6%, P = .73). In the subgroup analysis, interventional cardiology credentialing was not significantly associated with the inhospital major events (odds ratio 1.03; 95% confidence interval, 0.56 to 1.88; P = .80). Primary operator specialty and other characteristics for TAVR were not associated with a difference in risk-adjusted inhospital outcomes. That may be due to the heart team model that allows proceduralists of different backgrounds to lend their expertise to the procedure.
Sections du résumé
BACKGROUND
Operator characteristics and outcome relationships have not been evaluated at the individual operator level.
METHODS
From New York State Department of Health Statewide Planning and Research Cooperative System, 5896 elective transfemoral transcatheter aortic valve replacement (TAVR) procedures performed by 161 operators between 2012 and 2016 were analyzed. We examined the following characteristics of the primary operator: specialty (surgery vs cardiology), sex, medical school location, experience of cardiology practice, interventional cardiology credentialing, past-year TAVR volume, and first year performing TAVR in New York State. The primary outcome was a composite of inhospital mortality, stroke, and acute myocardial infarction.
RESULTS
After adjusting for patient and other provider characteristics, there was no significant difference in the risk of major events between surgeons and cardiologists in performing TAVR (3.4% vs 3.6%, P = .60), between male operators and female operators (P = .80), and between operators who graduated from a US medical school and operators educated outside the United States (3.4% vs 3.6%, P = .73). In the subgroup analysis, interventional cardiology credentialing was not significantly associated with the inhospital major events (odds ratio 1.03; 95% confidence interval, 0.56 to 1.88; P = .80).
CONCLUSIONS
Primary operator specialty and other characteristics for TAVR were not associated with a difference in risk-adjusted inhospital outcomes. That may be due to the heart team model that allows proceduralists of different backgrounds to lend their expertise to the procedure.
Identifiants
pubmed: 32795521
pii: S0003-4975(20)31307-2
doi: 10.1016/j.athoracsur.2020.06.018
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
853-860Subventions
Organisme : FDA HHS
ID : U01 FD005478
Pays : United States
Organisme : FDA HHS
ID : U01 FD006936
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2021 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.