B-42 | Institutional Variation in Radiation Doses During Transcatheter Valvular Interventions: A Statewide Experience

High radiation doses during PCI have been associated with adverse health effects and vary significantly based on the performing institution. Yet, little is known about whether radiation doses during transcatheter valvular interventions vary between institutions, despite rapid increases in procedural volumes. Using data from a large statewide registry, TEER, TMVR, and TAVR procedures between Jan 1, 2020 – Dec 31, 2022 with an air kerma (AK) recorded were analyzed. Patient and procedural characteristics were compared between cases with AK ≥ 2 and < 2 Gy. Associations of variables with AK ≥ 2 Gy were investigated using Bayesian random effects modeling and median odds ratios for the performing hospital. Among 9,446 procedures across 30 hospitals, AK was ≥2 Gy in 533 cases (5.6%) and ≥5 Gy in 31 cases (0.3%). Wide variation in procedural AK was observed, with an institutional frequency of AK ≥2 Gy ranging from 0.0% to 29.5%. Bayesian modeling identified the performing hospital as more strongly associated with the odds of an AK ≥ 2 Gy than any patient or procedural factors (hospital median odds ratio 3.54 [90% credible interval 2.5, 16.7]). In a large, multicenter state-wide registry, there is wide institutional variability in patient-level radiation doses during transvalvular valvular interventions, with the performing hospital being associated with AK doses ≥ 2 Gy more so than any patient or procedural factors. Based on these observations and the known harmful effects of ionizing radiation, future interventions are warranted to reduce procedural-related variation in radiation doses.