Using cadaver simulation to improve communication and economy of movement as evidence of progress with the trans-catheter aortic valve implantation (TAVI) learning curve

Trans-catheter Aortic Valve Implantation (TAVI) is an endovascular treatment for critical aortic stenosis. An early "learning curve" is important drawback of TAVI that can dramatically alter patient safety and hospital costs. There is paucity of data regarding the quantification of learning experience associated with the technique. The aim of this study was to assess learning curve in clinical staff involved in the implementation of TAVI. We hypothesize that training sessions will improve economy of movement (EoM) as characterized by measuring jerkiness of trunk movement in medial-lateral direction. Using wearable technology based on tri-axial accelerometer, the EoM of a scrub technician, who was naive to TAVI procedure, was assessed during 6 consecutive TAVI procedures, including 4 cadaver TAVI simulations and 2 clinical cases. In addition, communication errors between the surgery team were monitored. During the cadaver simulation training, the communication error was reduced by 46.2%. Similarly, the EoM was enhanced by 17.3% (p=0.04) with a nonsignificant reduction rate of 4.99±4.26% per practice. Interestingly, both communication errors and EoM were reduced during real cases compared to the first simulated case, suggesting that cadaver simulation translated into real cases. This proof of concept study suggests that EoM could be used as an alternative method to objectively evaluate the learning curve during surgical procedures. Results should be confirmed in a larger sample size in both physicians and support staff assisting with TAVI procedure.