Table 3.

Minimum Procedural Volume Typically Necessary for the Development and Demonstration of Interventional Cardiology Competencies

Procedure/Technical Skill	Minimum Number of Procedures∗	Notes
INTERVENTIONAL PROCEDURES	250	Includes a minimum of 200 percutaneous coronary interventions. The remaining 50 procedures could include any combination of coronary, peripheral artery, or structural heart interventions.
CORONARY INTERVENTIONS (required)
Percutaneous coronary interventions	200	Includes exposure to a broad range of adult patient ages, clinical presentations, pathologies, and therapies, including a range of anatomical lesion subsets, in de novo and previously stented vessels, such as thrombotic, ostial, bifurcation, and heavily calcified lesions, bypass grafts, and chronic total occlusion.
Adjunctive procedures
▪Coronary physiology	25	Includes fractional flow reserve and nonhyperemic pressure ratio.
▪Intracoronary imaging	25	Use of intravascular ultrasound and additional devices as available (optical coherence tomography).
PERIPHERAL VASCULAR INTERVENTIONS (optional based on practice focus)
Peripheral artery interventions	100 diagnostic procedures 50 interventional procedures (with half as primary operator†)	Includes exposure to lower extremity, subclavian, innominate, renal, mesenteric, and chronic limb ischemia.
Carotid stenting	25 (with 13 as primary operator†)	Carotid numbers can count toward numbers for peripheral artery interventions.
Endovascular aortic aneurysm repair	20 (with 10 as primary operator†)	Specialized advanced training for endovascular aneurysm repair is required in addition to the required peripheral artery interventions.
Peripheral venous interventions	20	Includes broad exposure to acute and chronic pulmonary embolism interventions, deep vein thrombosis intervention, dialysis access angioplasty and stenting, and inferior vena cava filter placement and retrieval. A minimum of 5 cases of any individual procedure is required to demonstrate competence in that specific procedure in addition to the required peripheral artery interventions.
STRUCTURAL HEART INTERVENTIONS (optional based on practice focus)
Transcatheter aortic valve replacement	50 (with 25 as primary operator†)	For practitioners solely focused on TAVR, this minimum volume is required.
Left atrial appendage closure	10	In addition to the minimum number shown, a foundation of 50 lifetime transcatheter structural heart procedures, including a minimum of 20 transseptal procedures (10 as primary operator†) through an intact septum (ie, non-PFO), is required to demonstrate competency for these procedures.
Transcatheter mitral valve edge-to-edge repair	20
Mitral balloon valvuloplasty	5
Patent foramen ovale closure	12
Atrial septal defect closure	15

PFO ​= patent foramen ovale; TAVR ​= transcatheter aortic valve replacement.

^∗Numbers are based on consensus, are intended as general guidance, and represent the cumulative experience that may occur at any time during training. Competency to perform each procedure must be based on evaluation and documentation by the Interventional Cardiology Training Program Director through direct observation and feedback from the Accreditation Council for Graduate Medical Education Clinical Competency Committee or the program director or training supervisor for peripheral vascular and structural heart interventions. Industry standards should be met when available.

^†The primary operator is defined as the interventionalist performing the critical portions of the procedure, either independently or under direct supervision.