Abstract 16661: Impact of the Learning Curve on Outcome After Transcatheter Mitral Valve Repair: First Results From the German Mitral Valve Registry
INTRODUCTION: Catheter-based treatment of mitral regurgitation (MR) has increasingly been used as an alternative treatment option to surgery. New complex catheter-based techniques are frequently subject to a steep learning curve.
PURPOSE: Evaluation of the impact of growing operator experience with percutaneous mitral repair on procedural success and complications.
METHODS: This is an analysis of patients in the German Mitral Valve Registry who underwent percutaneous mitral valve repair for MR. Consecutive patients treated since 2009 in centers that performed more than 20 transcatheter mitral repairs were included. Results of the first half of the patients were compared to those of the second among centers that treated less than 30 patients. Among centers with more than 30 patients results of the first 15 patients were compared to those of the last 15 patients. Primary endpoint was hospital death; secondary endpoints were postprocedural complications and 30-day mortality.
RESULTS: 181 patients from 6 centers were included. There was no significant difference in baseline characteristics, NYHA grade and MR severity between the first and last patients. In almost all procedures the MitraClip® device (97.2%) was used. The EuroSCORE was 27.0% in patients treated first vs. 19.0% in patients treated later (p= 0.05). Procedural success was 94.3% (83/88) in the first cases and 94.6% (87/92) subsequently. There was no significant difference in hospital (3.4% vs. 1.2%, p= 0.32) or 30-day mortality (14.0% vs. 11.9%; p=0.78) between patients treated first compared to those treated subsequently. However, postprocedural complications were significantly higher in patients treated first compared to those treated later (24.4% vs. 10.7%, p< 0.05) largely related to vascular access (serious bleeding 8% vs. 0%).
CONCLUSION: A learning curve using a catheter-based approach to treat MR does not appear to affect the procedural success or 30-day and perioperative mortality. However, it does have a significant impact on the rate of postprocedural complications, mainly related to vascular access.
- © 2011 by American Heart Association, Inc.