Influence of Failure to Rescue on Mortality After Transcatheter Aortic Valve Replacement

Q: What are the key findings of this study?

Failure to rescue from post-TAVR complications is associated with a disproportionately higher risk of death at medium- and high-mortality centers (P<.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Transcatheter Aortic Valve Replacement (TAVR). Intervention: Failure to rescue (FTR) vs. Tertiles of hospital mortality. Primary outcome: Hospital mortality (p=< .001).

Q: What does this research mean for the field?

Failure to rescue from post-TAVR complications is associated with a disproportionately higher risk of death at medium- and high-mortality centers, driving the significant variation in national TAVR mortality rates despite comparable complication rates. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Muath Bishawi; Christopher Jensen; Andrew M. Vekstein; Andrzej S. Kosinski; Fred Grover; J. Kevin Harrison; Vinod H. Thourani; Ajay J. Kirtane; Joseph E. Bavaria; Sreekanth Vemulapalli; G. Chad Hughes

doi:10.1016/j.atssr.2025.03.011

April 4, 2025Annals of Thoracic Surgery Short ReportsOpen Access

Influence of Failure to Rescue on Mortality After Transcatheter Aortic Valve Replacement

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Key result

Medium- and high-mortality centers are linked to disproportionately higher failure to rescue from post-TAVR complications.

P<.001

Figures

Graphical abstract published by Annals of Thoracic Surgery Short Reports — Graphical abstract · Published by Annals of Thoracic Surgery Short Reports · CC BY

Why the study?

Mortality after TAVR varies across centers, and failure to rescue patients from post-TAVR complications may represent an unexplored opportunity for process improvement.

Does treatment at higher-mortality centers increase failure to rescue (mortality after complications) in patients undergoing transfemoral TAVR?

Study Design

Type

Observational

Multicenter

Yes

Structured PICO

Does treatment at higher-mortality centers increase failure to rescue (mortality after complications) in patients undergoing transfemoral TAVR?

P

Population

61,804 patients undergoing transfemoral TAVR for primary aortic stenosis or mixed stenosis/insufficiency between 2011 and 2016 across 429 sites in the US STS/ACC TVT registry.

I

Intervention

Treatment at medium- or high-mortality TAVR centers (based on tertiles of observed-to-expected procedural mortality)

C

Comparator

Treatment at low-mortality TAVR centers

O

Outcome

Failure to rescue (FTR) rate, defined as procedural mortality (in-hospital or within 75 days) after developing a post-TAVR complicationhard clinical

Main Result

p-value: p=< .001

Differences in hospital mortality after TAVR are primarily driven by a center's ability to rescue patients from complications (failure to rescue) rather than the frequency of the complications themselves.

Limitations

Highly reliant on reporting quality at the center level
STS predicted risk of mortality score may not fully capture patient-specific risks unique to TAVR
Does not identify the underlying causes or specific care pathways contributing to differences in FTR rates

Implication

Rescue processes may drive TAVR mortality variation; leaves open whether targeted interventions reduce deaths.

Abstract

Background: Mortality after transcatheter aortic valve replacement (TAVR) varies among centers. "Failure to rescue" (FTR) patients from post-TAVR complications may represent an unexplored opportunity for TAVR process improvement. Methods: The Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy registry was queried for patients undergoing transfemoral TAVR between 2011 and 2016. Hospital FTR rate was derived from the ratio of observed-to-expected procedural mortality. Multivariable logistic regression models assessed the association between FTR and hospital mortality. Adjusted FTR rates were compared across tertiles of hospital mortality. Conclusions: National TAVR mortality rates vary significantly across centers, despite comparable rates of postoperative complications. Patients at medium- and high-mortality centers face a disproportionately higher risk of death due to FTR. These findings highlight the need for a closer evaluation of post-TAVR care processes to address this disparity.

Discussion

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Cite This Study

Bishawi et al. (2025) conducted an observational in Transcatheter Aortic Valve Replacement (TAVR). Failure to rescue (FTR) vs. Tertiles of hospital mortality was evaluated on Hospital mortality (p=< .001). Failure to rescue from post-TAVR complications is associated with a disproportionately higher risk of death at medium- and high-mortality centers (P<.001).

synapsesocial.com/papers/6a1c37e5d54006be995fba00 https://doi.org/10.1016/j.atssr.2025.03.011

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Influence of Failure to Rescue on Mortality After Transcatheter Aortic Valve Replacement

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Influence of Failure to Rescue on Mortality After Transcatheter Aortic Valve Replacement

Figures

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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