Case Volumes and Outcomes of Early-Career Operators Performing TAVR in the United States

BACKGROUND: Operator experience is a key determinant of outcomes after transcatheter aortic valve replacement (TAVR). However, whether early-career operators achieve comparable results to more experienced peers is unknown. Herein, we evaluate case volumes, patient risk profiles, and 30-day outcomes of early-career versus non–early-career operators performing TAVR in the United States. METHODS: Using the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapies Registry, we identified isolated TAVR procedures from October 2011 through March 2024. Early-career status was defined as ≤5 years in independent practice (based on board certification or first TAVR date); non–early-career status was >5 years. Multivariable hierarchical models adjusted for patient-, procedural-, operator-, and site-level factors, including annualized institutional TAVR volume, while accounting for clustering of procedures within operators and operators within sites. Primary outcomes were 30-day mortality and a composite of death, stroke, major bleeding, stage III acute kidney injury, or moderate-to-severe paravalvular leak. RESULTS: A total of 634 723 TAVR procedures were performed by 3126 operators across 847 sites, including 90 376 (14.2%) by early-career operators. Median annualized lifetime volume was lower for early-career operators (13 [interquartile range, 5–31] versus 19 [interquartile range, 7–42] cases per year; P <0.001). After adjustment, 30-day mortality was similar between early-career and non–early-career operators (2.38% versus 2.44%; risk ratio, 0.97 [95% CI, 0.92–1.01]; P =0.293), whereas the composite end point was lower among early-career operators (11.19% versus 11.77%; risk ratio, 0.95 [95% CI, 0.93–0.98]; P <0.001). CONCLUSIONS: In a national TAVR registry, early-career operators performed fewer cases but achieved similar 30-day mortality and a modestly lower adjusted composite event rate relative to more experienced peers. These findings suggest that within the structured, team-based environment of contemporary TAVR programs, early-career status alone is not associated with inferior procedural outcomes and should not be viewed as a barrier to independent practice.