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At hospital level, surgical AVR quality predicts TAVR mortality
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Hospitals with higher surgical aortic valve replacement mortality rates also had higher short-term and long-term transcatheter aortic valve replacement mortality rates, researchers reported.
The researchers analyzed 51,924 TAVR procedures performed in 519 hospitals between Jan. 1, 2010 and Sept. 29, 2015 to determine if hospitals with good surgical AVR outcomes had good TAVR outcomes after launching TAVR programs.
The hospitals were stratified into quartiles based on risk-adjusted 30-day mortality for surgical AVR from before an institution’s TAVR program began. This served as a surrogate for surgical AVR quality, Harun Kundi, MD, from the Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, division of cardiovascular medicine, Beth Israel Deaconess Medical Center, and colleagues wrote.
The outcomes of interest were 30-day and 1-year TAVR mortality rates.
Thirty-day TAVR mortality rates rose with increasing surgical AVR risk-adjusted mortality (quartile 1, 4.6%; quartile 2, 5%; quartile 3, 5.1%; quartile 4, 5.6%; P < .001), Kundi and colleagues wrote.
The researchers observed a similar trend for 1-year TAVR mortality rates (quartile 1, 17%; quartile 2, 17.5%; quartile 3, 18.2%; quartile 4, 18.6%; P < .001).
After multivariable adjustments, the trends persisted for 30-day TAVR mortality (OR for quartile 2 vs. quartile 1 = 1.02; 95% CI, 0.87-1.21; OR for quartile 3 vs. quartile 1 = 1.13; 95% CI, 1.02-1.26; OR for quartile 4 vs. quartile 1 = 1.23; 95% CI, 1.07-1.4; P for trend = .02) and 1-year TAVR mortality (HR for quartile 2 vs. quartile 1 = 1.04; 95% CI, 0.92-1.17; OR for quartile 3 vs. quartile 1 = 1.14; 95% CI, 1.02-1.28; OR for quartile 4 vs. quartile 1 = 1.16; 95% CI, 1.05-1.28; P for trend = .02).
In a related editorial, John D. Carroll, MD, professor of cardiology at the University of Colorado School of Medicine and director of interventional cardiology at the University of Colorado Hospital, Denver, wrote the data support “a new and underappreciated association of TAVR outcomes.”
The study “provides further insights into factors that may impact the results of the TAVR procedure.” Carroll wrote. “It provides support for the heart team concept. These two important forms of aortic valve replacement, SAVR and TAVR, will continue to evolve and will require ongoing research for clinicians to understand how to optimize care for patients with valvular heart disease.” – by Erik Swain
Disclosure: One author reports he consults for Abbott, Medtronic and Teleflex and received research grants from Abiomed and Boston Scientific. Carroll reports he serves as an investigator or a member of the data safety monitoring board for trials sponsored by Abbott, Edwards Lifesciences and Medtronic.
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