There is a correlation between the volume of conventional surgical aortic valve replacement procedures and better outcomes in transcatheter aortic valve replacement (TAVR), with higher 30-day and 1-year mortality in sites with lower volume. This is a probable indication that a good surgical team is complemented by a good hemodynamic team and, ultimately, a good heart team that carefully selects which patients will be assigned to each strategy.
Additionally, there is much evidence indicating that interventional cardiologist experience has a significant impact on outcomes. This work solidifies our understanding that the whole team’s experience (and not only individual operator experience) is important.
Researchers assessed 208,400 patients who underwent heart surgery from 2012 to 2015. Sites were classified according to the volume of surgeries during the study period. The primary endpoint was mortality at 30 days and at 1 year after TAVR.
A total of 65,757 patients underwent surgical valve replacement and 42,967 underwent TAVR. Among TAVR procedures, 21.7% (n = 9324) were performed at hospitals with <100 surgeries per year, 35.6% at sites with 100 to 199 surgeries, 22.9% at sites with 200 to 299, and 19.8% at hospitals with over 300 surgical aortic valve replacement procedures per year.
Mortality at 30 days was 30% higher in sites with <100 surgeries and 25% in sites with 100 to 199 surgeries, compared with sites with >300 surgeries (odds ratio [OR]: 1.32; 95% confidence interval [CI]: 1.18 to 1.47, and OR: 1.25; 95% CI: 1.12 to 1.39, respectively). The difference in relation to sites with 200 to 299 surgeries was not significant.
The aforementioned differences persisted one year after TAVR.
Conclusion
The total volume of surgical aortic valve replacement procedures at a site is well correlated with TAVR outcomes for the same site. Sites with <100 surgeries per year have the highest mortality rate with TAVR. These data support the notion that surgical programs go hand in hand with TAVR programs, and that a minimum of surgical procedures should be considered as an additional metric for TAVR outcomes.
Original title: Relationship Between Hospital Surgical Aortic Valve Replacement Volume and Transcatheter Aortic Valve Replacement Outcomes.
Reference: Sameer A. Hirji et al. J Am Coll Cardiol Intv 2020;13:335–43.
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