How many TAVR centers is enough?
Mortality rates fell for transcatheter aortic valve replacement in the first 4 years following its U.S. introduction, as operators grew more competent with the procedure; the improvement was particularly marked for those doing higher volumes of procedures.
That raises a question: Does the U.S. need more TAVR centers? Dr. John Carroll of Denver’s University of Colorado Hospital presented data on almost 43,000 TAVR procedures from the ACC/STS TVT Registry, including hospitals performing just a handful of TAVR cases and centers performing more than 600 a year.
Mortality rates fell from roughly 5% for the 1st few patients to between 3% and 4% after the first 100 patients, Carroll said. Improvements continued even after the 1st 100 patients, with mortality falling to 3% after 200 patients and to 2% for centers performing at least 400 procedures annually, he said. Similar declines were shown in analyses that adjusted for factors including new iterations of TAVR devices.
Higher volume did not, however, ensure better outcomes. Some low-volume centers had “excellent outcomes,” Carroll noted, while some higher-volume centers fell short. Read more