Influence of center surgical aortic valve volume on outcomes of transcatheter aortic valve replacementCentral MessagePerspective
Matthew Gandjian, MD,
Arjun Verma,
Zachary Tran, MD,
Yas Sanaiha, MD,
Peter Downey, MD,
Richard J. Shemin, MD,
Peyman Benharash, MD
Affiliations
Matthew Gandjian, MD
Cardiovascular Outcomes Research Laboratory, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif
Arjun Verma
Cardiovascular Outcomes Research Laboratory, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif
Zachary Tran, MD
Cardiovascular Outcomes Research Laboratory, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif
Yas Sanaiha, MD
Cardiovascular Outcomes Research Laboratory, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif
Peter Downey, MD
Cardiovascular Outcomes Research Laboratory, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif
Richard J. Shemin, MD
Cardiovascular Outcomes Research Laboratory, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif; Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif
Peyman Benharash, MD
Cardiovascular Outcomes Research Laboratory, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif; Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, Calif; Address for reprints: Peyman Benharash, MD, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, 10833 Le Conte Ave, 64-249 CHS, Los Angeles, CA 90095.
Objective: The utilization of transcatheter aortic valve replacement (TAVR) technology has exceeded that of traditional surgical aortic valve replacement (SAVR). In addition, the role of minimum surgical volume requirements for TAVR centers has recently been disputed. The present work evaluated the association of annual institutional SAVR caseload on outcomes following TAVR. Methods: The 2012-2018 Nationwide Readmissions Database was queried for elective TAVR hospitalizations. The study cohort was split into early (Era 1: 2012-2015) and late (Era 2: 2016-2018) groups. Based on restricted cubic spline modeling of annual hospital SAVR caseload, institutions were dichotomized into low-volume and high-volume centers. Multivariable regressions were used to determine the influence of high-volume status on in-hospital mortality and perioperative complications following TAVR. Results: An estimated 181,740 patients underwent TAVR from 2012 to 2018. Nationwide TAVR volume increased from 5893 in 2012 to 49,983 in 2018. After adjustment for relevant patient and hospital factors, high-volume status did not alter odds of TAVR mortality in Era 1 (adjusted odds ratio, 0.94; P = .52) but was associated decreased likelihood of mortality in Era 2 (adjusted odds ratio, 0.83; P = .047). High-volume status did not influence the risk of perioperative complications during Era 1. However, during Era 2, patients at high-volume centers had significantly lower odds of infectious complications, relative to low-volume hospitals (adjusted odds ratio, 0.78; P = .002). Conclusions: SAVR experience is associated with improved TAVR outcomes in a modern cohort. Our findings suggest the need for continued collaboration between cardiologists and surgeons to maximize patient safety.
