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Published on: August 8, 2025
The Impact of Institutional Volume on Transcatheter Aortic Valve Replacement Outcomes
Priya Joshi1, Karan Patel1, Ang Sun2,3
1Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Insights
Higher institutional transcatheter aortic valve replacement (TAVR) volume is linked to better patient outcomes. Increased TAVR procedural volume was associated with shorter hospital stays and lower mortality rates.
Area of Science:
- Cardiovascular Medicine
- Health Services Research
- Medical Quality Improvement
Background:
- Prior research indicates a correlation between high procedural volume and improved clinical outcomes in healthcare.
- Institutional procedural volume is a recognized factor influencing patient care quality and safety.
Purpose of the Study:
- To investigate the association between institutional transcatheter aortic valve replacement (TAVR) volume and key patient outcomes.
- To identify specific metrics most sensitive to variations in TAVR procedural volume.
Main Methods:
- Analysis of 91,494 non-impella-assisted TAVR procedures across 118 US hospitals from 2022-2024.
- Institutions stratified by annual case volume categories.
- Comparison of outcomes (length of stay, early mortality, ICU stay, observed mortality) using ANOVA and ANCOVA, adjusting for case mix index (CMI).
Main Results:
- Higher institutional TAVR volume significantly correlated with shorter mean length of stay (LOS) across all analyzed years (2022-2024).
- Increased volume was associated with significantly lower early mortality in 2023 and lower overall observed mortality in 2024.
- No significant association was found between TAVR volume and mean ICU stay.
Conclusions:
- Higher institutional TAVR volume is independently associated with improved patient outcomes, including reduced LOS and mortality.
- These findings suggest intrinsic differences in care delivery across different procedural volume strata, even after adjusting for patient complexity (CMI).
- Volume-outcome relationships in TAVR highlight potential areas for quality improvement initiatives.
Abstract:
Prior studies have demonstrated a consistent association between higher institutional procedural volume and improved clinical outcomes. To evaluate the relationship between institutional transcatheter aortic valve replacement (TAVR) volume and key patient outcomes, and to identify which metrics are most sensitive to volume variation. We analyzed 91,494 non-impella-assisted TAVR procedures performed at 118 US hospitals using the Vizient Clinical Data Base (28,077 in 2022; 30,602 in 2023; 32,815 in 2024). Annual case volume categories (e.g., 1-100 through 801-900) were used to stratify institutions. Key outcomes-including mean length of stay (LOS), early mortality, mean ICU stay, and observed mortality-were compared across volume groups using ANOVA and ANCOVA to adjust for case mix index (CMI). Higher institutional TAVR volume was significantly associated with shorter mean LOS in 2022 (ANOVA p = 0.0007; ANCOVA p < 0.0001), 2023 (ANOVA p = 0.0016; ANCOVA p = 0.0003), and 2024 (ANOVA p < 0.0001; ANCOVA p < 0.0001). In 2023, higher volume was associated with significantly lower early mortality (ANOVA p = 0.0195; ANCOVA p = 0.0165). In 2024, higher volume correlated with significantly lower overall observed mortality (ANOVA p = 0.0004; ANCOVA p < 0.0001). No significant associations were found between volume and mean ICU stay in any year. Higher institutional TAVR volume is independently associated with improved outcomes, including reduced LOS, early mortality, and overall observed mortality. These associations persist after adjustment for CMI, suggesting intrinsic differences in care delivery across volume strata.