TY - JOUR
T1 - Relationship Between Hospital Surgical Aortic Valve Replacement Volume and Transcatheter Aortic Valve Replacement Outcomes
AU - Hirji, Sameer A.
AU - McCarthy, Ellen
AU - Kim, Dae
AU - McGurk, Siobhan
AU - Ejiofor, Julius
AU - Ramirez-Del Val, Fernando
AU - Kolkailah, Ahmed A.
AU - Rosner, Bernard
AU - Shook, Douglas
AU - Nyman, Charles
AU - Berry, Natalia
AU - Sobieszczyk, Piotr
AU - Pelletier, Marc
AU - Shah, Pinak
AU - O'Gara, Patrick
AU - Kaneko, Tsuyoshi
N1 - Funding Information:
This study was supported by Sundry funds and Harvard Catalyst, the Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health award UL 1TR002541). Dr. Kaneko has served as a proctor and an educator for Edwards Lifesciences. Dr. Shah is a proctor and an educator for Edwards Lifesciences; and is an educator for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Funding Information:
This study was supported by Sundry funds and Harvard Catalyst, the Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health award UL 1TR002541). Dr. Kaneko has served as a proctor and an educator for Edwards Lifesciences. Dr. Shah is a proctor and an educator for Edwards Lifesciences; and is an educator for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2020 American College of Cardiology Foundation
PY - 2020/2/10
Y1 - 2020/2/10
N2 - Objectives: The aim of this study was to examine whether hospital surgical aortic valve replacement (SAVR) volume was associated with corresponding transcatheter aortic valve replacement (TAVR) outcomes. Background: Recent studies have demonstrated a volume-outcome relationship for TAVR. Methods: In total, 208,400 fee-for-service Medicare beneficiaries were analyzed for all aortic valve replacement procedures from 2012 to 2015. Claims for patients <65 years of age, concomitant coronary artery bypass grafting surgery, other heart valve procedures, or other major open heart procedures were excluded, as were secondary admissions for aortic valve replacement. Hospital SAVR volumes were stratified on the basis of mean annual SAVR procedures during the study period. The primary outcomes were 30-day and 1-year post-operative TAVR survival. Adjusted survival following TAVR was assessed using multivariate Cox regression. Results: A total of 65,757 SAVR and 42,967 TAVR admissions were evaluated. Among TAVR procedures, 21.7% (n = 9,324) were performed at hospitals with <100 (group 1), 35.6% (n = 15,298) at centers with 100 to 199 (group 2), 22.9% (n = 9,828) at centers with 200 to 299 (group 3), and 19.8% (n = 8,517) at hospitals with ≥300 SAVR cases/year (group 4). Compared with group 4, 30-day TAVR mortality risk-adjusted odds ratios were 1.32 (95% confidence interval: 1.18 to 1.47) for group 1, 1.25 (95% confidence interval: 1.12 to 1.39) for group 2, and 1.08 (95% confidence interval: 0.82 to 1.25) for group 3. These adjusted survival differences in TAVR outcomes persisted at 1 year post-procedure. Conclusions: Total hospital SAVR volume appears to be correlated with TAVR outcomes, with higher 30-day and 1-year mortality observed at low-volume centers. These data support the importance of a viable surgical program within the heart team, and the use of minimum SAVR hospital thresholds may be considered as an additional metric for TAVR performance.
AB - Objectives: The aim of this study was to examine whether hospital surgical aortic valve replacement (SAVR) volume was associated with corresponding transcatheter aortic valve replacement (TAVR) outcomes. Background: Recent studies have demonstrated a volume-outcome relationship for TAVR. Methods: In total, 208,400 fee-for-service Medicare beneficiaries were analyzed for all aortic valve replacement procedures from 2012 to 2015. Claims for patients <65 years of age, concomitant coronary artery bypass grafting surgery, other heart valve procedures, or other major open heart procedures were excluded, as were secondary admissions for aortic valve replacement. Hospital SAVR volumes were stratified on the basis of mean annual SAVR procedures during the study period. The primary outcomes were 30-day and 1-year post-operative TAVR survival. Adjusted survival following TAVR was assessed using multivariate Cox regression. Results: A total of 65,757 SAVR and 42,967 TAVR admissions were evaluated. Among TAVR procedures, 21.7% (n = 9,324) were performed at hospitals with <100 (group 1), 35.6% (n = 15,298) at centers with 100 to 199 (group 2), 22.9% (n = 9,828) at centers with 200 to 299 (group 3), and 19.8% (n = 8,517) at hospitals with ≥300 SAVR cases/year (group 4). Compared with group 4, 30-day TAVR mortality risk-adjusted odds ratios were 1.32 (95% confidence interval: 1.18 to 1.47) for group 1, 1.25 (95% confidence interval: 1.12 to 1.39) for group 2, and 1.08 (95% confidence interval: 0.82 to 1.25) for group 3. These adjusted survival differences in TAVR outcomes persisted at 1 year post-procedure. Conclusions: Total hospital SAVR volume appears to be correlated with TAVR outcomes, with higher 30-day and 1-year mortality observed at low-volume centers. These data support the importance of a viable surgical program within the heart team, and the use of minimum SAVR hospital thresholds may be considered as an additional metric for TAVR performance.
KW - aortic valve replacement
KW - heart valve prosthesis
UR - http://www.scopus.com/inward/record.url?scp=85078288339&partnerID=8YFLogxK
U2 - 10.1016/j.jcin.2019.09.048
DO - 10.1016/j.jcin.2019.09.048
M3 - Article
C2 - 32029250
AN - SCOPUS:85078288339
SN - 1936-8798
VL - 13
SP - 335
EP - 343
JO - JACC: Cardiovascular Interventions
JF - JACC: Cardiovascular Interventions
IS - 3
ER -