Operator characteristics and outcome relationships have not been evaluated at the individual operator level.
New York State Department of Health Statewide Planning and Research Cooperative System from 5,896 elective transfemoral 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), gender, 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 in-hospital mortality, stroke, and/or 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-value = 0.60), between male operators and female operators (p-value = 0.80), and between operators who graduated from a US medical school and operators educated outside the US (3.4% vs. 3.6% p-value = 0.73). In the subgroup analysis, interventional cardiology credentialing was not significantly associated with the in-hospital major events (OR=1.03, 95%CI (0.56-1.88), p-value = 0.80).
Primary operator specialty and other characteristics for TAVR were not associated with a difference in risk-adjusted in-hospital outcomes. This may be due to the heart team model that allows proceduralists of different backgrounds to lend their expertise to the procedure.
Copyright © 2020. Published by Elsevier Inc.