Failure to rescue after TAVR: New study tracks outcomes at high- and low-volume hospitals
Hospitals that perform a large number of transcatheter aortic valve replacement (TAVR) procedures are known to be associated with fewer major complications and a lower mortality risk. According to new data published in JACC: Cardiovascular Interventions, however, the failure to rescue (FTR) rate after TAVR at higher- and lower-volume hospitals are similar.
The study’s authors detailed two possible explanations for this inverse relationship between TAVR volumes and patient outcomes.
“First, high-volume centers may have reduced complication rates due to more experience and hence fewer subsequent deaths due to complications,” wrote first author Tayyab Shah, MD, a researcher with the Hospital of the University of Pennsylvania, and colleagues. “Second, high-volume centers may have lower FTRT rates—meaning the risk of death following a major complication—because of improved experience and systems of care to address complications. Both are plausible and have been identified as reasons for lower mortality at high-volume centers for other surgeries.”
Exploring years of TAVR data
To learn more, Shah et al. explored data from nearly 500,000 TAVR patients with a median age of 79 years old. Patients were treated at one of 808 sites from 2017 to 2023. All data came from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry.
As one may expect, 30-day mortality and major complications were significantly less common at low-volume hospitals. On the other hand, the rates of FTR—defined as 30-day risk-adjusted mortality following a major TAVR complication—were not significantly different from one facility to the next.
Among patients who experienced complications, the FTR rate across all hospitals was 11%--and that rate appeared to slowly decrease over time.
“Our study demonstrates that the inverse volume-mortality relationship seen across TAVR hospitals appears to be mostly related to increased complication rates at low-volume centers rather than differences in FTR rates,” the authors wrote. These findings … demonstrate that in the contemporary TAVR era, higher-volume centers are still not inherently better at rescuing patients experiencing post-TAVR complications. Potential explanations for this may include the fact that major complications (particularly catastrophic ones with very high FTR rates) are relatively rare and stochastic, with little experience gained in managing them even at the highest volume centers.”
Looking forward, Shah and colleagues emphasized the importance of always working to find new ways to improve patient care.
“In particular, focusing efforts on preventing catastrophic complications with relatively high variability across centers and high associated mortality by using best practices may help lower-volume centers in underserved areas maintain quality,” the group wrote. “The development of new artificial intelligence tools for preprocedural TAVR planning based on imaging data is particularly promising in this regard because these tools can provide accurate preprocedural planning information (valve sizing, deployment location and so forth) to minimize these complications at a similar level to that of an experienced operator/imager who is not always available at lower-volume centers.”
The researchers also wrote that FTR rates “cannot be ignored” just because they are comparable across different facilities.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.