Author + information
- Received May 16, 2019
- Revision received September 3, 2019
- Accepted September 17, 2019
- Published online February 3, 2020.
- Sameer A. Hirji, MD, MPHa,
- Ellen McCarthy, PhD, MPHb,
- Dae Kim, MD, ScD, MPHb,c,
- Siobhan McGurk, BSa,
- Julius Ejiofor, MD, MPHa,
- Fernando Ramirez-Del Val, MD, MPHa,
- Ahmed A. Kolkailah, MDa,
- Bernard Rosner, PhDd,
- Douglas Shook, MDe,
- Charles Nyman, MDe,
- Natalia Berry, MDc,
- Piotr Sobieszczyk, MDc,
- Marc Pelletier, MD, MSca,
- Pinak Shah, MDc,
- Patrick O’Gara, MDc and
- Tsuyoshi Kaneko, MDa,∗ ()
- aDivision of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bInstitute for Aging Research, Hebrew Senior Life, Division of Gerontology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
- cDepartment of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- dDivision of Pharmacoepidemiology & Pharmacoeconomics, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- eDepartment of Anesthesia, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Tsuyoshi Kaneko, Brigham and Women’s Hospital, Division of Cardiac Surgery, 15 Francis Street, Boston, Massachusetts 02115.
Objectives The aim of this study was to examine whether hospital surgical aortic valve replacement (SAVR) volume was associated with corresponding transcatheter aortic valve replacement (TAVR) outcomes.
Background Recent studies have demonstrated a volume-outcome relationship for TAVR.
Methods In total, 208,400 fee-for-service Medicare beneficiaries were analyzed for all aortic valve replacement procedures from 2012 to 2015. Claims for patients <65 years of age, concomitant coronary artery bypass grafting surgery, other heart valve procedures, or other major open heart procedures were excluded, as were secondary admissions for aortic valve replacement. Hospital SAVR volumes were stratified on the basis of mean annual SAVR procedures during the study period. The primary outcomes were 30-day and 1-year post-operative TAVR survival. Adjusted survival following TAVR was assessed using multivariate Cox regression.
Results A total of 65,757 SAVR and 42,967 TAVR admissions were evaluated. Among TAVR procedures, 21.7% (n = 9,324) were performed at hospitals with <100 (group 1), 35.6% (n = 15,298) at centers with 100 to 199 (group 2), 22.9% (n = 9,828) at centers with 200 to 299 (group 3), and 19.8% (n = 8,517) at hospitals with ≥300 SAVR cases/year (group 4). Compared with group 4, 30-day TAVR mortality risk-adjusted odds ratios were 1.32 (95% confidence interval: 1.18 to 1.47) for group 1, 1.25 (95% confidence interval: 1.12 to 1.39) for group 2, and 1.08 (95% confidence interval: 0.82 to 1.25) for group 3. These adjusted survival differences in TAVR outcomes persisted at 1 year post-procedure.
Conclusions Total hospital SAVR volume appears to be correlated with TAVR outcomes, with higher 30-day and 1-year mortality observed at low-volume centers. These data support the importance of a viable surgical program within the heart team, and the use of minimum SAVR hospital thresholds may be considered as an additional metric for TAVR performance.
This study was supported by Sundry funds and Harvard Catalyst, the Harvard Clinical and Translational Science Center (National Center for Advancing Translational Sciences, National Institutes of Health award UL 1TR002541). Dr. Kaneko has served as a proctor and an educator for Edwards Lifesciences. Dr. Shah is a proctor and an educator for Edwards Lifesciences; and is an educator for St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received May 16, 2019.
- Revision received September 3, 2019.
- Accepted September 17, 2019.
- 2020 American College of Cardiology Foundation
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