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For TAVR, Inverse Link Identified for Hospital Volume, Mortality

WEDNESDAY, April 3, 2019 -- Hospital volume is inversely associated with mortality for transfemoral transcatheter aortic-valve replacement (TAVR) procedures, according to a study published online April 3 in the New England Journal of Medicine.

Sreekanth Vemulapalli, M.D., from the Duke University Medical Center in Durham, North Carolina, and colleagues analyzed data regarding procedural volume and outcomes from 2015 through 2017 from the Transcatheter Valve Therapy Registry. The authors examined the correlation between hospital procedural volume and risk-adjusted mortality at 30 days after transfemoral TAVR.

A transfemoral approach was involved in 84.7 percent of the 113,662 TAVR procedures performed at 555 hospitals by 2,960 operators. The researchers identified a significant inverse correlation between annualized volume of transfemoral TAVR procedures and mortality. Compared with hospitals in the highest-volume quartile, those in the lowest-volume quartile had higher and more variable adjusted 30-day mortality (3.19 versus 2.66 percent; odds ratio, 1.21). The difference in adjusted mortality was a relative reduction of 19.45 percent between a mean annualized volume of 27 procedures in the lowest-volume quartile and 143 procedures in the highest-volume quartile. Thirty-day mortality remained higher in the lowest versus the highest quartile after exclusion of the first 12 months of TAVR procedures at each hospital (3.10 versus 2.61 percent; odds ratio, 1.19).

"A volume-mortality association persists in the United States for transfemoral TAVR, as well as TAVR using nontransfemoral approaches, despite improved patient selection, technology, and techniques," the authors write.

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Posted: April 2019

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