Simonato Matheus, Vemulapalli Sreekanth, Ben-Yehuda Ori, Wu Changfu, Wood Larry, Popma Jeff, Feldman Ted, Krohn Carole, Hardy Karen M, Guibone Kimberly, Christensen Barbara, Alu Maria C, Chen Shmuel, Ng Vivian G, Chau Katherine H, Shahim Bahira, Vincent Flavien, MacMahon John, James Stefan, Mack Michael, Leon Martin B, Thourani Vinod H, Carroll John, Krucoff Mitchell
Yale School of Medicine, New Haven, Connecticut.
Duke Clinical Research Institute, Durham, North Carolina.
Ann Thorac Surg. 2022 May;113(5):1730-1742. doi: 10.1016/j.athoracsur.2022.01.018. Epub 2022 Mar 30.
Transcatheter aortic valve replacement (TAVR) is the standard of care for severe, symptomatic aortic stenosis. Real-world TAVR data collection contributes to benefit/risk assessment and safety evidence for the U.S. Food and Drug Administration, quality evaluation for the Centers for Medicare and Medicaid Services and hospitals, as well as clinical research and real-world implementation through appropriate use criteria. The essential minimum core dataset for these purposes has not previously been defined but is necessary to promote efficient, reusable real-world data collection supporting quality, regulatory, and clinical applications. The authors performed a systematic review of the published research for high-impact TAVR studies and U.S. multicenter, multidevice registries. Two expert task forces, one from the Predictable and Sustainable Implementation of National Cardiovascular Registries/Heart Valve Collaboratory and another from The Society of Thoracic Surgeons/American College of Cardiology TVT (Transcatheter Valve Therapy) Registry convened separately and then met to reconcile a final list of essential data elements. From 276 unique data elements considered, unanimous consensus agreement was achieved on 132 "core" data elements, with the most common reasons for exclusion from the minimum core dataset being burden or difficulty in accurate assessment (36.9%), duplicative information (33.3%), and low likelihood of affecting outcomes (10.7%). After a systematic review and extensive discussions, a multilateral group of academicians, industry representatives, and regulators established 132 interoperable, reusable essential core data elements essential to supporting more efficient, consistent, and informative TAVR device evidence for regulatory submissions, safety surveillance, best practice, and hospital quality assessments.
经导管主动脉瓣置换术(TAVR)是重度症状性主动脉瓣狭窄的标准治疗方法。真实世界的TAVR数据收集有助于美国食品药品监督管理局进行获益/风险评估和安全性论证,有助于医疗保险和医疗补助服务中心以及医院进行质量评估,还能通过合理使用标准推动临床研究和真实世界应用。此前尚未定义用于这些目的的基本最小核心数据集,但对于促进高效、可重复使用的真实世界数据收集以支持质量、监管和临床应用而言,该数据集是必要的。作者对已发表的高影响力TAVR研究及美国多中心、多设备注册研究进行了系统评价。两个专家特别工作组,一个来自国家心血管注册研究/心脏瓣膜协作组的可预测和可持续实施项目,另一个来自胸外科医师协会/美国心脏病学会经导管瓣膜治疗(TVT)注册研究,分别召开会议,然后会合以协调确定基本数据元素的最终清单。在考虑的276个独特数据元素中,就132个“核心”数据元素达成了一致共识,被排除在最小核心数据集之外的最常见原因是评估负担或困难(36.9%)、重复信息(33.3%)以及影响结局的可能性低(10.7%)。经过系统评价和广泛讨论,一个由院士、行业代表和监管机构组成的多边小组确定了132个可互操作、可重复使用的基本核心数据元素,这些元素对于支持更高效、一致和信息丰富的TAVR设备证据以用于监管申报、安全监测、最佳实践和医院质量评估至关重要。