Patients treated with transcatheter aortic valve replacement (TAVR) for bicuspid aortic stenosis are less likely to be discharged with a disability if treated at a high-volume structural heart center, according to new data presented Thursday at the Society of Cardiovascular Angiography and Interventions 2020 virtual conference.
The research correspondence by Nicolas Kassis, MD, of Cleveland Clinic Foundation, and colleagues was simultaneously published online in JACC: Cardiovascular Interventions.
The study analyzed the outcomes of 1,626 patients treated between 2012 and 2017 across the United States. Using data gathered from the National Readmissions Database, the investigators categorized patients on the basis of the center’s annual volume of TAVR procedure. Low-volume centers were defined as less than or equal to 100 cases per year, and high-volume centers performed more than 100 cases per year.
The results show that patients treated at high-volume centers were more likely to have heart failure, renal failure, diabetes and prior myocardial infarctions. Despite having more comorbidities, patients at high-volume centers had a lower risk of being discharged with a disability than patients at low-volume centers (odds ratio, 0.655; 95% confidence interval, 0.523 – 0.820; p<0.001). The risk of mortality or having a stroke in the hospital was similar, irrespective of where the procedure was performed.
The authors also wrote that the rates of stroke were higher than those seen in patients with trileaflet aortic stenosis treated with TAVR at both high- (3.6%) and low- (2.8%) volume centers.
The authors cautioned, however, that “our study is inherently limited by its reliance on administrative reporting and inability to account for potential confounders, including device type, operator experience, patient selection, and, notably, the varied use of embolic protection devices across hospitals. Nonetheless, our data reflect current practice and suggest that aggressive stroke prevention strategies should be pursued in patients with (bicuspid aortic valves who are to undergo TAVR.”
The study was funded by an institutional gift from Jennifer and Robert McNeill. The authors reported no conflicts of interest in relation to the published findings.
Kassis N, Saad AM, Hariri E, et al. Impact of Hospital Procedural Volume on Transcatheter Aortic Valve Replacement for Bicuspid Aortic Valve. JACC Cardiovasc Interv 2020 May 14. https://doi.org/10.1016/j.jcin.2020.04.007