Introducing transapical aortic valve implantation (part 1): Effect of a structured training program on clinical outcome in a series of 500 procedures

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Presentation transcript:

Introducing transapical aortic valve implantation (part 1): Effect of a structured training program on clinical outcome in a series of 500 procedures Miralem Pasic, MD, PhD, Axel Unbehaun, MD, Stephan Dreysse, MD, Semih Buz, MD, Thorsten Drews, MD, Marian Kukucka, MD, Alexander Mladenow, MD, Giuseppe D’Ancona, MD, PhD, Roland Hetzer, MD, PhD, Burkhardt Seifert, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 4, Pages 911-918 (April 2013) DOI: 10.1016/j.jtcvs.2012.12.057 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Procedures versus calendar time according to surgeon. Of 5 surgeons, the first and most experienced performed first 100 procedures. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 911-918DOI: (10.1016/j.jtcvs.2012.12.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Kaplan-Meier survival functions of A, whole cohort of 500 patients and subgroups of patients (Pts.) B, according to surgeon, C, patients with and without cardiogenic shock, and D, according to gender. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 911-918DOI: (10.1016/j.jtcvs.2012.12.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Unadjusted cumulative failure chart with 30-day mortality of study cohort showing clusters of failure (deaths) during short period after indexed procedure 100, 175, and 300 correlating with point of reduction of internal proctoring (and forcing a return to a greater level of internal proctoring). The Journal of Thoracic and Cardiovascular Surgery 2013 145, 911-918DOI: (10.1016/j.jtcvs.2012.12.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 Learning curve of 30-day mortality (logistic regression analysis) showing absence of typical greater values (ie, absence of mortality increase) at beginning. No significant change seen in 30-day mortality throughout study period. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 911-918DOI: (10.1016/j.jtcvs.2012.12.057) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions