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Procedural Volume and Outcomes for Transcatheter Aortic-Valve Replacement
Sreekanth Vemulapalli1, John D Carroll1, Michael J Mack1
1From the Division of Cardiology, Duke University Medical Center (S.V.), the Duke Clinical Research Institute (S.V., Z.L., D.D., A.S.K.), and the Department of Biostatistics and Bioinformatics, Duke University (A.S.K.) - all in Durham, NC; the Division of Cardiology, Department of Medicine, University of Colorado, Aurora (J.D.C.); Baylor Scott and White Heart Hospital, Plano (M.J.M.), and the Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas (D.J.K.) - both in Texas; the Division of Cardiology, Hackensack Meridian School of Medicine at Seton Hall University, Hackensack, NJ (C.E.R.); the Division of Cardiothoracic Surgery, Medstar Heart and Vascular Institute and Georgetown University, Washington, DC (V.H.T.); the Division of Cardiology, William Beaumont Hospital, Royal Oak, MI (G.H.); the University of Pittsburgh School of Medicine, Pittsburgh (T.G.G.); the Divisions of Cardiology (H.C.H.) and Cardiothoracic Surgery (J.E.B.), University of Pennsylvania, Philadelphia; and the Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco (R.G.B.).
Higher hospital volume for transcatheter aortic-valve replacement (TAVR) is linked to better patient outcomes. This study found that hospitals performing more TAVR procedures had lower 30-day mortality rates, supporting volume-based policies.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
Background:
- Transcatheter aortic-valve replacement (TAVR) is a critical procedure for aortic valve disease.
- US Centers for Medicare and Medicaid Services mandated procedural volume requirements for TAVR reimbursement.
- Understanding the link between hospital TAVR volume and patient outcomes is crucial for policy development.
Purpose of the Study:
- To investigate the association between hospital procedural volume and patient outcomes for TAVR.
- To inform policy decisions regarding TAVR procedural volume requirements.
Main Methods:
- Analysis of data from the Transcatheter Valve Therapy Registry (2015-2017).
- Examined the association between continuous hospital procedural volume and risk-adjusted 30-day mortality after transfemoral TAVR.
- Secondary analysis by quartile of hospital volume, with sensitivity analysis excluding the initial 12 months of procedures.
Main Results:
- A significant inverse association was found between annualized transfemoral TAVR volume and mortality.
- Adjusted 30-day mortality was higher in the lowest-volume quartile (3.19%) compared to the highest-volume quartile (2.66%).
- A relative reduction in mortality of 19.45% was observed between the lowest and highest volume quartiles, persisting after sensitivity analysis.
Conclusions:
- An inverse volume-mortality relationship exists for transfemoral TAVR.
- Hospitals with lower procedural volumes exhibited higher and more variable 30-day mortality rates.
- Findings support the importance of procedural volume in TAVR outcomes.
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