The Learning Curve and Annual Procedure Volume Standards for Optimum Outcomes of Transcatheter Aortic Valve Replacement an International

OBJECTIVES The authors aimed to determine the procedural learning curve and minimum annual institutional volumes associated with optimum clinical outcomes for transcatheter aortic valve replacement (TAVR). BACKGROUND Transcatheter aortic valve replacement (TAVR) is a complex procedure requiring signi fi cant training and experience for successful outcome. Despite increasing use of TAVR across institutions, limited information is available for its learning curve characteristics and minimum annual volumes required to optimize clinical outcomes. METHODS The study collected data for patients at 16 centers participating in the international TAVR registry since initiation of the respective TAVR program. All cases were chronologically ordered into initial (1 to 75), early (76 to 150), intermediate (151 to 225), high (226 to 300), and very high ( > 300) experience operators for TAVR learning curve charac-terization. In addition, participating institutions were strati fi ed by annual TAVR case volume into low-volume ( < 50), moderate-volume (50 to 100), and high-volume ( > 100) groups for comparative analysis. Procedural and 30-day

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