Surgical volume not related to transcatheter outcomes in mitral valve repair
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There was no relationship between institutional volume of mitral valve surgery or transcatheter mitral valve repair and transcatheter mitral valve repair outcomes, according to research presented at the American College of Cardiology Scientific Session.
The findings may cast doubt on proposed changes to Medicare coverage policies that would require a hospital to conduct 40 mitral surgeries annually or 80 over 2 years before introducing a transcatheter mitral valve repair (TMVR) program, the researchers wrote in a simultaneous publication in JACC: Cardiovascular Interventions.
In the retrospective, claims-based analysis, Medicare beneficiaries who underwent mitral valve surgery at low-volume institutions (1 to 24 surgeries per year) or medium-volume institutions (25 to 39 surgeries per year) had higher rates of in-hospital mortality compared with patients at high-volume institutions, defined as those with 40 or more surgeries per year (OR for low vs. high = 1.57; 95% CI, 1.28-1.94; OR for medium vs. high = 1.31; 95% CI, 1.03-1.67).
In contrast, for patients who underwent TMVR, mortality and cardiac hospitalization rates did not vary significantly by institutional volumes for either mitral valve surgery or TMVR, the researchers reported.
“From a policy perspective, our findings do not support increasing the annual mitral valve surgery volume required to start a TMVR center,” Colin M. Barker, MD, director of interventional cardiology and associate professor of medicine at Vanderbilt University Medical Center, and colleagues wrote in the research letter.
“From a clinical perspective, our findings confirm the association between hospital volume and mitral valve surgery outcomes,” the researchers wrote. “For TMVR, we observed low mortality rates for Medicare patients across all institutional volume levels, reflecting the fundamentally different risk profile of TMVR vs. surgery.
“Ultimately, the treatment decision is based on a multidisciplinary heart team that includes both experienced surgeons and interventional cardiologists,” the researchers wrote. “However, the lack of relationship between institutional mitral valve surgery volume and TMVR outcomes suggests that higher surgical volume is not related to better transcatheter outcomes.” – by Scott Buzby
References:
Barker CM, et al. Abstract 1252-028. Presented at: American College of Cardiology Scientific Session; March 28-30, 2020 (virtual meeting).
Barker CM, et al. JACC Cardiovasc Interv. 2020;doi:10.1016/j.jcin.2020.01.212.
Disclosures: The study was sponsored by Edwards Lifesciences. Barker reports he served on advisory boards for Boston Scientific and Medtronic and has been a consultant for Edwards Lifesciences. Please see the study for all other authors’ relevant financial disclosures.