Mao J, et al. - In this observational cohort study, researchers analyzed the relationship of hospital surgical aortic valve replacement (SAVR) and combined SAVR and transcatheter aortic valve replacement (TAVR) volumes with patient outcomes after TAVR procedures performed within 1 year, 2 years, and for the entire period after initiation of TAVR programs. Findings suggested that hospitals with higher volumes of SAVR had a higher likelihood of quickly implementing TAVR. They found that better TAVR results and hospital SAVR volume alone were not linked. Especially when hospitals had high SAVR volumes, amassing high volumes of TAVR was correlated with lower mortality following TAVR. Data indicated that the best results would likely be seen in hospitals with high caseloads of both SAVR and TAVR.

Methods

• This investigation involved 60,538 TAVR procedures performed in 438 hospitals between October 1, 2011 and December 31, 2015 among Medicare beneficiaries.
• Utilizing a hierarchical logistic regression model adjusting for patient and hospital characteristics, the relationship between SAVR volume, SAVR and TAVR volumes, and risks of death, death or stroke, and readmissions within 30 days were determined.
• Using a multivariable proportional hazard model with a robust variance estimator, the relationship between SAVR and SAVR and TAVR volumes and 1-year and 2-year mortality after TAVR procedures was determined.
• Researchers investigated the associations for procedures performed within 1 year, 2 years, and for the entire period after initiation of TAVR programs.

Results

• As per data, among the 60,538 patients, 29,173 were women and 31,365 were men, with a mean (SD) age of 82.3 (8.0) years.
• Findings suggested that hospitals with high SAVR volume (mean annual volume, ≥97 per year) were more likely to adopt TAVR early and had a higher growth in TAVR volumes over time (median TAVR volume by hospitals with high SAVR volume and low SAVR volume: year 1, 32 vs 19; year 2, 48 vs 28; year 3, 82 vs 38; year 4, 118 vs 54; P < .001).
• High hospital SAVR volume alone was not related to better patient outcomes after TAVR in adjusted analysis.
• When hospital TAVR and SAVR volumes were together analyzed, subjects treated in hospitals with high TAVR volume had lower 30-day mortality after TAVR (high TAVR and low SAVR vs low TAVR and low SAVR: odds ratio, 0.85; 95% CI, 0.72-0.99; high TAVR and high SAVR vs low TAVR and high SAVR: odds ratio, 0.81; 95% CI, 0.69-0.95), the impact of which was more pronounced when hospitals also had high SAVR volume.
• It was noted that patients treated in hospitals with high SAVR volume and high TAVR volume had the lowest 30-day mortality (vs hospitals with low SAVR volume and TAVR volume: odds ratio, 0.77; 95% CI, 0.66-0.89).