February 10, 2020
Study Demonstrates Relationship Between Hospital SAVR Volume and TAVR Outcomes
February 10, 2020—Sameer A. Hirji, MD, et al conducted a study that examined whether hospital surgical aortic valve replacement (SAVR) volume was associated with corresponding transcatheter aortic valve replacement (TAVR) outcomes. The investigators published the findings from the study in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2020;13:335–343).
The investigators concluded that total hospital SAVR volume appears to be correlated with TAVR outcomes, with higher 30-day and 1-year mortality observed at low-volume centers. They further stated that these data support the importance of a viable surgical program within the heart team, and the use of minimum SAVR hospital thresholds may be considered as an additional metric for TAVR performance.
As summarized in JACC: Cardiovascular Interventions, the study investigators analyzed 208,400 fee-for-service Medicare beneficiaries for all aortic valve replacement procedures from 2012 to 2015. The study excluded claims for patients < 65 years old, concomitant coronary artery bypass grafting surgery, other heart valve procedures, other major open heart procedures, and secondary admissions for aortic valve replacement.
Investigators stratified hospital SAVR volumes on the basis of mean annual SAVR procedures during the study period. The primary outcomes were 30-day and 1-year postoperative TAVR survival. Adjusted survival following TAVR was assessed using multivariate Cox regression.
A total of 65,757 SAVR and 42,967 TAVR admissions were evaluated. The TAVR procedures were organized as follows:
- Group 1: 21.7% (n = 9,324) that were performed at hospitals with < 100 SAVR cases per year
- Group 2: 35.6% (n = 15,298) at centers with 100 to 199 SAVR cases per year
- Group 3: 22.9% (n = 9,828) at centers with 200 to 299 SAVR cases per year
- Group 4: 19.8% (n = 8,517) at hospitals with ≥ 300 SAVR cases per year
Compared with group 4, 30-day TAVR mortality risk-adjusted odds ratios were:
- 1.32 (95% confidence interval [CI],1.18–1.47) for group 1
- 1.25 (95% CI, 1.12–1.39) for group 2
- 1.08 (95% CI, 0.82–1.25) for group 3
The adjusted survival differences in TAVR outcomes persisted at 1-year postprocedure, reported the investigators in JACC: Cardiovascular Interventions.