TAVR just as safe when performed by early-career operators
Early-career operators can still perform transcatheter aortic valve replacement (TAVR) at a level comparable to more experienced specialists, according to new findings published in Circulation: Cardiovascular Interventions.[1]
“TAVR has transformed the management of severe aortic stenosis with expanding indications and increasing procedural volumes across all surgical risk categories,” wrote first author Husam M. Salah, MD, a researcher with Duke University, and colleagues. “As TAVR volumes expand and indications broaden, both operator and institutional experience have emerged as critical determinants of procedural safety and patient outcomes.”
Salah et al. tracked data from more than 600,000 isolated TAVR procedures performed from October 2011 to March 2024. All data came from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry. Early-career operators—those with fewer than five years of experience—performed 14.2% of TAVR procedures during that time. The study’s primary outcomes were 30-day mortality and a composite of death, stroke, major bleeding, stage III acute kidney injury and moderate-to-severe paravalvular leak.
The 30-day mortality rates were 2.38% for early-career operators and 2.44% for all other operators. The composite endpoint, meanwhile, occurred in 11.19% of patients treated by early-career operators and 11.77% of those treated by all other operators.
“Contrary to our initial hypothesis, we found that early-career operators, despite lower cumulative procedural volumes, achieved similar risk-adjusted 30-day mortality and a modestly lower risk of the 30-day composite outcome relative to more experienced colleagues,” the authors wrote. “These results refine the established volume-outcome paradigm in TAVR and provide new insights into workforce development, credentialing, and the safe integration of early-career operators into structural heart practice.”
The group noted that this is different from what has been documented with percutaneous coronary intervention (PCI) procedures. When it comes to PCI, they wrote, early-career operators often treat higher-risk patients and then experience “modestly worse adjusted outcomes.” With TAVR, on the other hand, early-career operators were not necessarily asked to treat higher-risk patients.
“These findings suggest that within the contemporary structural heart environment, team-based practice and institutional safeguards may mitigate risks associated with operator inexperience, supporting the safe integration of early-career interventionalists into TAVR practice,” Salah and colleagues concluded.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.