Surgical Aortic Valve Outcomes With Transcatheter Aortic Valve Replacement Hospital Status.

Area of Science:

• Cardiovascular Surgery
• Health Services Research

Background:

• Aortic stenosis is treated with surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR).
• Some hospitals exclusively perform SAVR, lacking TAVR capabilities.
• This study compares SAVR outcomes between hospitals with differing TAVR adoption statuses.

Purpose of the Study:

• To compare the 30-day and 1-year mortality rates of SAVR procedures performed at SAVR-only hospitals versus hospitals that offer both SAVR and TAVR.
• To investigate potential disparities in SAVR patient outcomes based on institutional TAVR program presence.

Main Methods:

• Analysis of Medicare beneficiaries who underwent SAVR between January 2018 and June 2023.
• Logistic regression models were used to compare 30-day and 1-year mortality between SAVR-only and SAVR/TAVR hospitals from 2021 to 2023.

Main Results:

• A total of 98,003 SAVRs were analyzed, with 94,170 performed at SAVR/TAVR hospitals.
• From 2021-2023, SAVR-only hospitals showed significantly higher 30-day (7.3% vs. 5%) and 1-year (14.1% vs. 8.8%) mortality.
• All SAVRs at SAVR-only hospitals had increased odds of 30-day (OR 1.68) and 1-year (OR 1.77) mortality, but isolated SAVRs did not show this difference.

Conclusions:

• Overall SAVR mortality is higher at SAVR-only hospitals compared to SAVR/TAVR hospitals.
• The disparity in mortality is not present for isolated SAVR procedures.
• Further research is needed to determine if 'Center of Excellence' models effectively reduce SAVR mortality.