Surgical Aortic Valve Outcomes With Transcatheter Aortic Valve Replacement Hospital Status

Both surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) are treatments of aortic stenosis. There remain hospitals that perform SAVR and not TAVR. The study objective was to compare SAVR outcomes at SAVR-only hospitals with those at SAVR/TAVR hospitals.

Medicare beneficiaries who underwent SAVR from January 2018 to June 2023 were analyzed. Logistic regression analyses were performed to determine whether 30-day and 1-year mortality of patients undergoing SAVR differed between SAVR-only and SAVR/TAVR hospitals from 2021 to 2023.

A total of 98,003 SAVRs occurred from 2018 to 2023, including 94,170 performed at SAVR/TAVR hospitals. From 2021 to 2023, 30-day and 1-year mortality after SAVR was higher at SAVR-only hospitals than at SAVR/TAVR hospitals (7.3% vs 5% [P < .0001]; 14.1% vs 8.8% [P < .0001]). All SAVRs at SAVR-only hospitals had higher odds of both 30-day (odds ratio [OR], 1.68 [CI, 1.31-2.17]) and 1-year (OR, 1.77 [CI, 1.44-2.19]) mortality compared with SAVRs performed at SAVR/TAVR hospitals, whereas there was no difference in 30-day (OR, 1.22 [CI, 0.71-2.10]) or 1-year mortality (OR, 0.82 [CI, 0.58-1.19]) for isolated SAVRs.

Mortality after all SAVRs is higher at SAVR-only hospitals than at SAVR/TAVR hospitals, but not for isolated SAVR. Further research is needed to understand whether the Center of Excellence concept is the best avenue to improve SAVR mortality.