Institutional Variation in Patient Radiation Doses During Transcatheter Valve Interventions: A Statewide Experience.

Area of Science:

• Cardiology
• Interventional Cardiology
• Radiology

Background:

• Limited data exists on institutional radiation doses for transcatheter valve interventions.
• Understanding radiation exposure is crucial for patient safety in these procedures.

Purpose of the Study:

• To evaluate institutional variability in radiation doses during transcatheter valve interventions.
• To identify factors associated with higher radiation doses in these procedures.

Main Methods:

• Analysis of a large statewide registry of transcatheter edge-to-edge mitral valve repair, transcatheter mitral valve replacement, and transcatheter aortic valve replacement procedures (2020-2022).
• Comparison of patient and procedural characteristics for cases with air kerma (AK) ≥2 Gy versus <2 Gy.
• Bayesian random effects modeling to assess associations with AK ≥2 Gy, focusing on the performing hospital.

Main Results:

• 9,446 procedures across 30 hospitals were analyzed; median procedural AK was 0.592 Gy.
• 5.6% of cases had an AK ≥2 Gy, with institutional frequencies ranging from 0.0% to 29.5%.
• The performing hospital was the strongest predictor of AK ≥2 Gy (median OR: 3.54), outweighing patient or procedural factors.

Conclusions:

• Significant institutional variability exists in patient-level radiation doses during transcatheter valve interventions.
• The performing hospital is a key determinant of high radiation exposure, more so than patient or procedural characteristics.
• Interventions are needed to standardize and reduce procedural radiation exposure variation.