Hospitals Less Experienced With Transcatheter Aortic Valve Replacement Procedures Have Higher Risk Of Death: Study

Patients treated at hospitals that conduct fewer heart valve surgeries each year have higher death rate than those treated at hospitals that conduct more of the procedures, according to the findings of a new study. 

Transcatheter aortic-valve replacement (TAVR) procedures are an open-heart surgery alternative. However, researchers from Duke University indicate that hospitals performing the highest numbers of the operation have a 20% lower rate of death among patients than hospitals performing fewer of the procedures.

In findings published this month in the New England Journal of Medicine, researchers analyzed data from the Transcatheter Valve Therapy Registry and focused on procedural volumes and outcomes from 2015 to 2017. The study included nearly 114,000 TAVR procedures performed at 555 hospitals by nearly 3,000 surgeons.

Data indicated a significant inverse association between annual volume of TAVR procedures and the risk of death. This suggests the more procedures a hospital does, the lower their death rates are. Conversely, the fewer number of procedures done in a year, the higher the death rate the hospital had.

Hospitals with lower numbers of procedures had a death rate of 3.19%, while the hospitals with the highest volume of procedures had a rate of 2.66%. Researchers indicate this equates to a 20% difference in death rates.

“An inverse volume–mortality association was observed for transfemoral TAVR procedures from 2015 through 2017,” researchers concluded. “Mortality at 30 days was higher and more variable at hospitals with a low procedural volume than at hospitals with a high procedural volume.”

TAVR is a type of procedure that allows the surgeon to replace the heart valve in a less invasive way that doesn’t involve open chest surgery. It implants a replacement heart valve over the damaged aortic valve using a catheter instead of opening the patient’s chest.

Initially, it was mostly used on older patients, but has grown in popularity as the procedure has evolved over the years and offers patients shorter down time. However, in recent years, questions about the valves durability in younger patients have been raised.

A recent report indicated there is little long-term research to indicate if the valves are durable enough to last for longer periods of time in younger patients.

Despite the lack of long-term data regarding durability, companies continue to market the valves and procedure to younger patients as a less invasive option. However, doctors, researchers, and even the manufacturers who make the valves cannot say for certain if the devices will last the lifetime of a younger patient.