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Association Between Transcatheter Aortic Valve Implantation Volume and Outcomes in the United States

Published:October 03, 2015DOI:https://doi.org/10.1016/j.amjcard.2015.09.040
      With the rapid advance of transcatheter aortic valve implantation (TAVI), it is important to evaluate the relationship between TAVI volumes and outcomes. The aim of this study was to analyze in-hospital outcomes after TAVI stratified according to hospital volumes. Using the National Inpatient Sample files from 2012, hospitals performing transfemoral (TF)-TAVI and transapical (TA)-TAVI were divided into high-volume and low-volume centers. A total of 7,660 patients underwent TAVI in 256 hospitals in 2012. In the TF-TAVI cohort, multivariate logistic regression analyses demonstrated that low TF-TAVI volume status was an independent predictor of death and bleeding. In the TA-TAVI cohort, low volume status was a predictor of death, myocardial infarction, and need for permanent pacemaker. In addition, hospitals that performed low TA-TAVI volume were associated with significantly higher rate of death after surgical aortic valve replacement in comparison with the hospitals that perform high TA-TAVI volume (3.6% vs 2.3%, p <0.001). In conclusion, centers with lower volume of TAVI had more frequent adverse events compared with higher volume centers.
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      Linked Article

      • Hospital Volume and In-Hospital Outcomes After Transcatheter Aortic Valve Implantation
        American Journal of CardiologyVol. 117Issue 6
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          We read with great interest, Kim et al's1 study regarding the association of hospital volume with in-hospital outcomes after transcatheter aortic valve implantation (TAVI) in the United States. We would like to bring to the investigators' attention the results from our study using the Nationwide Inpatient Sample from 2012 published earlier this year.2 We also studied the impact of hospital volume divided into quartiles on in-hospital outcomes after TAVI. Our results demonstrated the highest hospital volume quartile to be significantly predictive of lower in-hospital mortality (odds ratio 0.38, 95% CI 0.27 to 0.54, p <0.001) and procedural complications after multivariate analysis.
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