Why the study?
Quality-of-care monitoring was historically performed separately for TAVR and SAVR, lacking a global report across high-volume treatments using consensus indicators.
How do quality indicators and mortality rates change over time for patients undergoing TAVR or SAVR for aortic stenosis?
Cohort (n=8,495)
Yes
How do quality indicators and mortality rates change over time for patients undergoing TAVR or SAVR for aortic stenosis?
Risk-adjusted mortality for transfemoral TAVR improved significantly over time, while surgical mortality remained low and stable, highlighting the utility of consensus quality indicators.
Mortality decline after TF TAVR supports quality surveillance; leaves open causal factors and generalizability.
Background: Historically, quality-of-care monitoring was performed separately for transcatheter and surgical aortic valve replacement (TAVR, SAVR). Using consensus indicators, we provide a global report on the quality of care for treatment of aortic stenosis across the highest-volume treatments: transfemoral (TF) TAVR, isolated SAVR, and SAVR combined with coronary artery bypass graft. Methods: Retrospective observational cohort study of consecutive patients in a regional system of care. Primary endpoint was 30-day and 1-year mortality (2015-2019). Secondary endpoints included rate of new pacemaker, rate of readmission, and length of stay (2012-2019). Following multivariable logistic regressions, we developed mortality case-mix adjustment models to report risk estimates. Results: = 0.09), respectively; surgical mortality rates for isolated SAVR and SAVR combined with coronary artery bypass graft were low and did not change significantly over time, ranging from 0.3% to 1.4% and from 0.9% to 3.4%, respectively at 30 days, and from 0.9% to 3.4% and from 4.7% to 6.7 at 1 year. In the TF TAVR cohort, the observed vs expected ratio for 30-day and 1-year mortality decreased significantly from 1.9 (95% confidence interval [CI] 0.9, 3.5) to 0.3 (95% CI 0.1, 0.8), and from 1.3 (95% CI 0.9, 1.7) to 0.7 (95% CI 0.5, 0.99), respectively; no change occurred in risk-adjusted surgical mortality. Conclusions: Consensus quality indicators provide unique insights on the quality of care for patients receiving treatment for aortic stenosis.
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Lauck et al. (2023) conducted a cohort in Aortic stenosis (n=8,495). Transcatheter and surgical aortic valve replacement over time (2015-2019) vs. Historical outcomes (earlier years within the cohort) was evaluated on 30-day all-cause mortality after transfemoral transcatheter aortic valve replacement (p=0.03).
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