Influence of Failure to Rescue on Mortality After Transcatheter Aortic Valve Replacement

Area of Science:

• Cardiovascular Medicine
• Health Services Research

Background:

• Transcatheter aortic valve replacement (TAVR) outcomes vary significantly across healthcare institutions.
• Failure to rescue (FTR), the inability to prevent death after a complication, is a potential driver of this variability.

Purpose of the Study:

• To investigate the association between hospital-specific FTR rates and post-TAVR mortality.
• To identify opportunities for improving TAVR process and patient outcomes.

Main Methods:

• Analysis of 61,804 transfemoral TAVR cases from the STS/ACC TVT registry (2011-2016).
• Calculation of hospital FTR rates using observed-to-expected procedural mortality ratios.
• Multivariable logistic regression to assess FTR's association with hospital mortality.

Main Results:

• Post-TAVR mortality was significantly higher in high-mortality hospitals (5.6%) compared to low-mortality hospitals (1.8%).
• Risk-adjusted complication rates showed minimal differences across hospital mortality tertiles.
• Adjusted FTR rates were substantially worse in high- and medium-mortality hospitals (14.6% and 9.5%) versus low-mortality centers (5.4%).
• Higher FTR rates were observed for complications including conversion to open surgery, stroke, and cardiac arrest in higher-mortality centers.

Conclusions:

• Significant disparities in TAVR mortality exist across centers, not fully explained by complication rates.
• Patients at higher-mortality centers have a disproportionately increased risk of death due to FTR.
• Focusing on post-TAVR care processes is crucial to address FTR and reduce mortality variations.