A scoping review to identify competencies for transcatheter cardiovascular procedures

Abstract

Objectives: Transcatheter procedures are increasingly being recognized as a priority for cardiac surgeons and cardiac surgery trainees. The optimal method of teaching these procedures during residency training has not been established. We used an evidence-based approach to systematically review the literature and identify competencies to inform future paradigms of transcatheter training in cardiac surgery.Methods: A scoping review was conducted to retrieve relevant literature on the performance of transcatheter cardiovascular procedures, identify competencies required by surgical residents learning to perform these procedures, and develop a preliminary list of competencies for consideration during transcatheter training. MEDLINE, Scopus, and ERIC were queried until April 1, 2020, using a systematic search strategy. No limitations were placed on publication date or type.Results: A total of 1456 sources of evidence were retrieved. After deduplication and screening, there remained 33 that were included in the scoping review, published between 2006 and 2020. The distribution of publication types included 10 comparative studies (30.3% of total), 8 societal statements (24.2% of total), 5 surveys and 5 opinion articles (each 15.2% of total), 2 editorials and 2 descriptions of a simulator (each 6.1% of total), and 1 narrative review (3.0% of total). From these, a total of 400 items were identified and organized into 97 competencies.Conclusions: Evidence on the competencies required to perform transcatheter cardiovascular procedures is available from a variety of sources. The identified competencies may be a useful resource for developing curricula and teaching transcatheter procedures to cardiac surgery residents. (J Thorac Cardiovasc Surg 2020;-:1-11) 97 competencies were identified These may inform future training in transcatheter cardiac surgery The identified competencies may inform future training in transcatheter cardiac surgery. CENTRAL MESSAGEThis scoping review has identified relevant competencies that may facilitate evidence-based approaches to teaching transcatheter cardiovascular procedures to surgical residents. PERSPECTIVEA broad body of literature on performing transcatheter cardiovascular procedures is available. Lack of cohesion among sources of evidence may be impeding the efforts of cardiac surgeons to learn these procedures and teach them to residents. This scoping review has identified an evidence-based set of competencies to facilitate the teaching of transcatheter cardiovascular procedures.See Commentary on page XXX.The recent growth of endovascular therapies has led to significant changes in the way which care is delivered. Endovascular repair has emerged as an acceptable and sometimes preferable alternative to open surgery for disease of the thoracic aorta. [1][2][3][4] Many cardiovascular diseases that were previously the domain of open surgery are also now treatable using transcatheter alternatives. Supported by results from randomized controlled trials, 5-8 more transcatheter aortic valve repl...

Commentary: An all-access pass to transcatheter aortic valve replacement

“…This has revolutionized the treatment of aortic stenosis, but also produced several unanswered questions with regard to valve durability, subclinical leaflet thrombosis, permanent pacemaker insertion with subsequent rehospitalization, the evolving role of TAVR in low-risk patients, and preparing future cardiac surgeons for practices that include transcatheter techniques. [3][4][5] Naturally, although transfemoral TAVR (TF-TAVR) is the preferred route, questions surrounding the ideal alternative access have persisted for those patients not suitable for TF-TAVR.…”

“…The same could be asked of centers with adequate experience and results using any 1 of the available alternative routes because the relationship between surgical volume and outcomes is well known. 8 Obtaining appropriate vascular access and securing adequate closure are among the most commonly identified competencies related to transcatheter procedures, 4 further emphasizing the importance of expertise in these procedural elements in both transfemoral and alternative access. 3 The safety of any alternative route is therefore likely contingent on institutional and operator experience, with all forms of alternative access (including transthoracic) TAVR capable of being performed safely in experienced hands.…”

Commentary: Transcatheter cardiac surgery training: What to teach?

“…Muller Moran and colleagues 5,6 previously published the results of a scoping review, identifying 97 competencies for transcatheter procedures. In this issue of the Journal, they survey Canadian physicians and refine the previously identified skills using a modified Delphi approach.…”