Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement.
Avoiding the Learning Curve for Transcatheter Aortic Valve Replacement.
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DOI：
10.1155/2017/7524925
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发表时间：
2017
影响因子：
2.1
通讯作者：
Garcia S
中科院分区：
文献类型：
--
作者：
Gurevich S;John R;Kelly RF;Raveendran G;Helmer G;Yannopoulos D;Biring T;Oestreich B;Garcia S
目标。评估现有和新的经导管主动脉瓣置换术（TAVR）方案之间的合作是否有助于减少达到最佳效率所需的病例数。背景。在TAVR程序中实现程序效率和安全性有一个充分记录的学习曲线。方法。在新项目启动前一年，明尼阿波利斯退伍军人医疗中心（新项目）和明尼苏达大学（2012年成立项目，n = 219）之间建立了多学科合作。结果：269例患者接受TAVR治疗（50例在新方案的第一年接受治疗）。平均年龄76（±18）岁，STS评分6.8（±6）分。途径包括经股（n = 35, 70%）、经根尖（n = 8, 16%）、经主动脉（n = 2, 4%）和锁骨下（n = 5, 10%）。手术效率（手术时间158±59对148±62，p = 0.27）、器械成功率（96%对87%，p = 0.08）、住院时间（5±3对6±7天，p = 0.10）和安全性（住院死亡率4%对6%，p = 0.75）在两个方案之间相似。在新项目的第一年，我们发现第一名和最后25名患者的结果测量没有差异。结论。与已建立的项目建立伙伴关系可以帮助缓解与这些复杂程序相关的学习曲线。
Objectives. To evaluate whether collaboration between existing and new transcatheter aortic valve replacement (TAVR) programs could help reduce the number of cases needed to achieve optimal efficiency. Background. There is a well-documented learning curve for achieving procedural efficiency and safety in TAVR procedures. Methods. A multidisciplinary collaboration was established between the Minneapolis VA Medical Center (new program) and the University of Minnesota (established program since 2012, n = 219) 1 year prior to launching the new program. Results. 269 patients treated with TAVR (50 treated in the first year at the new program). Mean age was 76 (±18) years and STS score was 6.8 (±6). Access included transfemoral (n = 35, 70%), transapical (n = 8, 16%), transaortic (n = 2, 4%), and subclavian (n = 5, 10%) types. Procedural efficiency (procedural time 158 ± 59 versus 148 ± 62, p = 0.27), device success (96% versus 87%, p = 0.08), length of stay (5 ± 3 versus 6 ± 7 days, p = 0.10), and safety (in hospital mortality 4% versus 6%, p = 0.75) were similar between programs. We found no difference in outcome measures between the first and last 25 patients treated during the first year of the new program. Conclusions. Establishing a partnership with an established program can help mitigate the learning curve associated with these complex procedures.