Abstract Body (Do not enter title and authors here): Background: There is a well-established relationship between volume and outcomes among TAVR operators. However, there is little data about the association of years of experience of a TAVR operator and outcomes.
Methods: Using data from the TVT Registry between 2011-2024, we examined the career stage of TAVR operators (including interventional cardiologists and cardiothoracic surgeons) using TVT NPI data and the American Board of Internal Medicine (ABIM) database to determine date of independent practice. We examined the association between years in practice and 30-day outcomes (mortality and composite outcome of death, stroke, major bleeding, stage III AKI and PVL). We excluded operators with missing NPI numbers, and operators who had performed <10 TAVRs. An early career TAVR operator was defined as an operator within the first 5 years of independent practice. We performed a sensitivity analysis where the early career operator cut-off wasa 10 years in practice.
Results: During the study period, there were 3,126 TAVR operators at 847 sites treating 634,723 patients undergoing TAVR. Depending on year of the study, between 12-24% of TAVR patients were treated by early career operators. The median age of patients treated by early vs. non-early career were both 80 years, and patients cared for by early career were more likely on home oxygen and less likely elective (all p<0.001). The median operator annual volume by years in practice rose from years 1-4 in practice, and then remained nearly constant at 18 TAVRs/year (Figure 1a). The median STS risk score did not change by years of independent practice (constant at 4%), Figure 1b. The rates of 30-day death for early career were 2.4% and for non-early career were 2.5% (risk ratio 0.95, 95% CI 0.90-0.99, p=0.018). The rates of the 30-day composite outcome were 11.1% for early career and 11.9% for non-early career (risk ratio 0.93, 95% 0.91-0.95, p<0.001. The same trends occurred when the early career cut-off occurred at 10 years.
Conclusions: Median annual number of TAVRs performed by U.S. operators remains low overall. Early career TAVR operators were more likely to perform non-elective cases and to care for patients with more comorbidities. Despite this, early career operators had lower rates of 30-day mortality and composite outcomes.