Utilizing a Flagship Proctor Model to Establish a New Regional Hospital Transcatheter Aortic Valve (TAVR) Program
Derek Nieber, M.D.1, Robert M. Minutello, M.D.1, Stephanie L. Mick, M.D.1, Irene Pilosova, PA2, Samuel J. Lang, M.D.1, Leonard N. Girardi, M.D.1, Charles A. Mack, M.D.1.
1Weill Cornell Medicine, New York, NY, USA, 2The New York Presbyterian-Queens, Flushing, NY, USA.
OBJECTIVE: To demonstrate the effect of utilizing a proctor team model to establish a new TAVR program.
METHODS: In July 2020 a TAVR program was initiated at a regional hospital. A proctoring team from the systemís high-volume flagship hospital was involved in the first 20 TAVRs. The team was comprised of experienced high-volume practitioners including an interventional cardiologist, cardiac anesthesiologists, imaging cardiologists and cardiac surgeon. Each member of the flagship team proctored the corresponding member of the regional team for the first 20 cases. The subsequent 30 cases were performed by the regional team alone. Patient age, sex, STS risk score, mortality, complications, post-TAVR echocardiograms, post-TAVR length of stay (LOS), and total LOS were compared between groups and with STS/ACC TVT Registry benchmark data.
RESULTS: 50 patients underwent TAVR at a regional hospital from July 2020 through May 2021. Mean age was 82.8 years, 34% were female. There were no outcomes differences between proctored and unproctored groups, and outcomes met or exceeded national benchmarks (Table 1). There were no mortalities or strokes. Mean STSPROM score was 4.78. The new pacemaker rate was 10%. 92% of patients demonstrated no/trivial aortic insufficiency (AI) and 8% demonstrated mild AI, with no cases >mild AI. Median post-TAVR LOS was 1 day, median total LOS was 2 days. CONCLUSIONS: A flagship proctor team model facilitates the launch of a new TAVR program, and may allow a new program to produce outcomes equivalent to national quality benchmarks from its inception.
|Regional Hospital||TVT Registry 2020 Benchmark|
|STS Risk Score (<3%)||34%||44.8%|
|STS Risk Score (>=3% and <8%)||48%||43.2%|
|STS Risk Score (>=8%)||8%||12%|
|Major Bleeding Event||0||2.6%|
|Post TAVR No or Trivial Aortic Insufficiency||92%||88%|
|Post TAVR Mild Aortic Insufficiency||8%||11%|
|Median LOS (days) : Post TVR/Total||1/2||1/1|
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