Introducing transapical aortic valve implantation (part 2): institutional structured training program

J Thorac Cardiovasc Surg. 2013 Apr;145(4):919-925. doi: 10.1016/j.jtcvs.2012.12.085. Epub 2013 Feb 4.


Objectives: Introduction of a new procedure has a typical learning curve with the "learning phase" at the beginning, characterized by an increased mortality or complication rate. We developed our institutional structured training program for transcatheter aortic valve implantation (TAVI) with the aim of eliminating these negative effects.

Methods: The program regulated the introduction of TAVI and building and training of the team. It combines cumulative knowledge from the field with the institutional and individual background experience. It includes stepwise acquisition of the tools necessary for the preoperative strategic planning, perioperative team communication, technical aspects of the procedure, and postoperative management. The program establishes a basis for interaction and feedback between the members of the team ("teach and learn"; "be proctor and proctored").

Results: The program consists of 4 main parts: general principles, team building, team education and training, and the institutional clinical and procedural policies. The program possesses several control mechanisms, eg, occasional external proctoring. Additionally, a chain of steps spontaneously generates further procedural improvements and optimizes the overall outcome. The program has also had a global positive effect on the local institutional environment, awaking awareness of existing latent conditions and active failures, identifying them and inducing their correction, which has led to general clinical improvement.

Conclusions: A structured educational training program enables implementation of a new procedure (TAVI) into clinical practice without increased morbidity and mortality rate during the learning curve. The program may also be used as a basis for any new device introduction into clinical practice.

MeSH terms

  • Aortic Valve / surgery*
  • Checklist*
  • Curriculum*
  • Heart Valve Prosthesis Implantation / education*
  • Heart Valve Prosthesis Implantation / methods*
  • Humans