Impact of surgical aortic valve and coronary intervention volume on transcatheter aortic valve replacement outcomes

Transcatheter aortic valve replacement (TAVR) centers must meet specific volume criteria. This study aimed to examine whether hospital surgical aortic valve replacement (SAVR) and percutaneous coronary intervention (PCI) volumes are associated with early TAVR outcomes.

We analyzed TAVR hospitalizations from the Hospital Quality Monitoring System in China (2016-2021). Hospitals were categorized into low- or high-volume centers based on the mean annual number of SAVR or PCI procedures. A case-sequence approach and multivariate regressions were used to evaluate the impact of high-volume status on in-hospital death or discharge against medical advice (DAMA) following TAVR.

Between 2016 and 2021, a total of 12,823 TAVR procedures were performed at 461 hospitals, with 8,314 selected for analysis. From the first to the 125th case in the volume-outcome model, there was a reduced risk-adjusted rate of in-hospital death or DAMA. Low hospital SAVR volume (<40 procedures/year) was associated with a higher in-hospital death or DAMA rate after TAVR. In contrast, low PCI volume (<300 procedures/year) did not significantly affect outcomes. The beneficial effect of high SAVR volume on TAVR outcomes remained consistent across different cut-off points for high- and low-volume hospitals, with favorable effects observed between 15.5 and 107 SAVR procedures per year.

High hospital SAVR volume was associated with better outcomes in early TAVR cases. However, higher PCI volumes were not linked to lower mortality rates after early TAVR. Adequate SAVR experience is crucial for hospitals planning to establish new TAVR programs.