Key result
Higher procedural volume is linked to lower mortality across complex surgical and transcatheter cardiac interventions.
Why the study?
Does treatment at high-volume centers or by high-volume operators improve outcomes and reduce mortality in patients undergoing complex cardiac interventions like TAVI?
Does treatment at high-volume centers or by high-volume operators improve outcomes and reduce mortality in patients undergoing complex cardiac interventions like TAVI?
Answers are grounded in this paper and cite their sources.
This review reinforces the 'practice makes perfect' paradigm, demonstrating that higher hospital and operator volumes for complex procedures like TAVI are strongly associated with reduced mortality and complications.
"Practice makes perfect" is an old saying that can be true for complex interventions. There is a strong and persistent relationship between high volume and better outcomes with more than 300 studies being reported on the subject. The more complex the procedure, the greater the volume-outcome relationship is. Failure to rescue was shown to be one of the factors explaining higher mortality rates post complex surgery. High-volume centers provide a better safety net, thanks to the structure and better protocols, and low-volume operators have better results at high-volume centers than at low-volume centers. Finally, effort should be made to regroup complex procedures in high-volume centers, but without compromising patient access to the procedures. Adaptation to local and geographic constraints is important.
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Mauler‐Wittwer et al. (2022) conducted a review in Complex cardiac interventions, percutaneous coronary interventions (PCI), and transcatheter aortic valve implantation (TAVI). High procedural volume vs. Low procedural volume was evaluated on Procedural outcomes including mortality and complications. High procedural volume is strongly and persistently associated with better clinical outcomes, including lower mortality and failure-to-rescue rates, across complex surgical and transcatheter cardiac interventions.
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