Kundi H, et al. - In this national cohort involving US patients aged ≥ 65 years, researchers investigated whether those hospitals with better patient outcomes for surgical aortic valve replacement (SAVR) subsequently achieved better transcatheter aortic valve replacement (TAVR) outcomes after the launch of TAVR programs. After initiating TAVR programs, hospitals with higher SAVR mortality rates also had higher short- and long-term TAVR mortality. Researchers suggested that the quality of cardiac surgical care can be linked to the performance of a hospital with new structural heart disease programs.

Methods

• Data collected January 1, 2010 to September 29, 2015 from the Centers for Medicare and Medicaid Services’ Medicare Provider and Review were utilized for this analysis.
• Hospitals performing ≥ 1 SAVR before September 1, 2011 and performing ≥ 1 TAVR after that date were also included.
• From June 2018 to August 2018, data analysis was completed.
• Intervention included isolated aortic valve replacements.
• Hospital risk-adjusted 30-day mortality for SAVR was used as a surrogate for SAVR quality in the pre-TAVR period.
• After quartile stratification of baseline hospital risk-adjusted SAVR mortality, the TAVR mortality rate was examined for 30 days and 1 year.

Results

• In total, 51,924 TAVR procedures were conducted in 519 hospitals, of which 19,798 were performed at hospitals in quartile 1 (the lowest risk-adjusted SAVR mortality rate), 7,663 were conducted in quartile 2, 10,180 were performed in quartile 3, and 14,283 were performed in quartile 4 (the highest risk-adjusted SAVR mortality rate).
• Mortality rates observed at 30 days increased consistently with increased baseline hospital SAVR risk-adjusted mortality.
• Similar patterns were observed for 1-year mortality.
• Compared with the lowest quartile of SAVR mortality, undergoing TAVR at a hospital with higher baseline SAVR mortality continued to be related to higher 30-day mortality after multivariable analysis.