Hospital Volume and Failure to Rescue Post-TAVR: Insights From the STS/ACC TVT Registry

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Medical Quality Improvement

Background:

• A known inverse relationship exists between hospital volume and mortality for transcatheter aortic valve replacement (TAVR).
• Higher mortality rates are observed in hospitals performing fewer TAVR procedures annually.
• Understanding the factors mediating this volume-mortality relationship is crucial for improving patient outcomes.

Purpose of the Study:

• To investigate whether the risk of major complications or failure to rescue (FTR) explains the observed inverse volume-mortality relationship in TAVR.
• To analyze the association between hospital TAVR volume and the rates of major complications and FTR.

Main Methods:

• Analysis of the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry data from 2017-2023.
• Inclusion of 487,159 patients who underwent TAVR across 808 hospitals.
• Comparison of 30-day risk-adjusted mortality, major complication rates, and FTR rates across hospitals stratified by TAVR volume quartiles.

Main Results:

• Lower-volume TAVR centers (Q1) exhibited significantly higher rates of 30-day mortality and major complications compared to high-volume centers (Q4).
• The overall rate of failure to rescue (FTR) was 11.0%, with no significant differences observed across hospital volume quartiles.
• Higher annualized TAVR volume was associated with lower complication rates, but not with significantly different FTR rates.

Conclusions:

• Higher hospital TAVR volume is associated with reduced rates of major complications.
• The study did not find a significant association between hospital TAVR volume and failure to rescue (FTR) rates.
• The inverse volume-mortality relationship in TAVR may be primarily driven by differences in complication rates rather than FTR.