Key result
Patients undergoing transfemoral transcatheter aortic valve replacement at hospitals in the lowest volume tertile had a significantly higher risk of in-hospital mortality compared to those at highest volume centers (OR 1.40).
Why the study?
The association between hospital procedural volume and clinical outcomes of TAVR remains poorly understood despite exponential growth in US hospitals offering the procedure.
Does higher hospital procedural volume improve clinical outcomes (mortality and readmission) in patients undergoing transfemoral TAVR?
Observational (n=232,581)
Yes
Does higher hospital procedural volume improve clinical outcomes (mortality and readmission) in patients undergoing transfemoral TAVR?
Odds Ratio: 1.4 (95% CI 1.21–1.62)
Absolute Event Rate: 1.6% vs 1.2%
p-value: p=<0.01
Higher hospital procedural volume for transfemoral TAVR is associated with significantly lower in-hospital mortality, 30-day mortality, and 30-day readmission rates.
Supports concentrating TAVR at higher-volume centers; leaves open optimal thresholds for referral or policy.
The number of hospitals offering transcatheter aortic valve replacement (TAVR) in the United States has increased exponentially over the past several years. Multiple prior studies have demonstrated an association between hospital volume and clinical outcomes of various cardiac procedures.1,2 However, the association between hospital procedural volume and clinical outcomes of TAVR is still poorly understood. In this study, the National Readmission Database was queried to identify all hospitalizations for patients who underwent TAVR between 2016 and 2019 in the United States using International Classification of Diseases, Tenth Revision codes.
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Altibi et al. (2022) conducted an observational in Aortic stenosis (n=232,581). Low hospital procedural volume (<150 TAVRs/year) vs. High hospital procedural volume (≥300 TAVRs/year) was evaluated on In-hospital mortality (OR 1.40, 95% CI 1.21-1.62, p=<0.01). Patients undergoing transfemoral transcatheter aortic valve replacement at hospitals in the lowest volume tertile had a significantly higher risk of in-hospital mortality compared to those at highest volume centers (OR 1.40).
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