CHICAGO — Low institutional volume may be linked to adverse outcomes after transcatheter aortic valve replacement (TAVR), a registry study suggested.
On risk adjustment, in-hospital mortality became less likely the more an institution performed TAVR (P=0.0232), according to John D. Carroll, MD, of the University of Colorado Denver, and colleagues.
Bleeding complications similarly diminished in probability as institutional TAVR cases accumulated (P<0.0001), prompting Carroll to conclude that “TAVR outcomes have substantially improved with increasing TAVR volume in the United States” during his presentation here at the American College of Cardiology 2016 Scientific Sessions.
Spencer B. King, MD, of Emory University in Atlanta, told MedPage Today that “there is a continuum of improvement with experience with TAVR, which is not surprising.”
“You do something a lot, you get better at it,” he said. He called Carroll’s study “incredibly pertinent” because of TAVR’s increasing popularity.
Yet sooner or later, he suggested, the stream of patients with aortic stenosis won’t be able to fill all the slots available at the institutions.
Study discussion panelist James B. Hermiller, MD, of St. Vincent’s Medical Group in Indianapolis, Ind., agreed: “Should we have 400 sites in the U.S.? The data would suggest no.”
King emphasized that the benefits of gaining familiarity with TAVR extend beyond the operating room, as all aspects of care need to be practiced sufficiently, from nursing and anesthesiology to post-care.
The data were collected from patients enrolled in the Society of Thoracic Surgeons/American College of Cardiology (ACC) TVT Registry between 2011 and 2015. Included were a total of 42,988 patients receiving commercial TAVR using FDA-approved devices.
“An association does not prove causality,” Carroll emphasized, even if the positive relationship between TAVR outcome and case sequence persisted following multivariable adjustment.
Carroll disclosed relationships with Direct Flow, Edwards LifeSciences, Medtronic, and Tendyne.
ACC 2016 Scientific Sessions
Carroll JD, et al “Relationship between procedure volume and outcome for transcatheter aortic valve replacement in U.S. clinical practice: insights from the STS/ACC TVT Registry” ACC 2016.