Volume-Outcome Relationship of Mortality Following Surgical Explant of Transcatheter Aortic Valve Replacements.

Abstract

Objective: This study evaluated the relationship between hospital volume of transcatheter aortic valve replacement (TAVR) Explants and post-operative mortality.

Methods: The Center for Medicare & Medicaid Services was queried from 2016-2024 for patients who underwent TAVR Explant. The study period was divided into two eras: early (2016-2021) and recent (2022-2024). Hospitals were grouped as low- or high-volume. Both 30-day and 1-year mortality were compared and multivariable analysis was performed.

Results: We identified 1,238 TAVR Explants. Of the 375 hospitals that performed a TAVR Explant, 235 (63%) performed fewer than three. Post-operative mortality at 30-days and 1-year was 13.3% and 18.3%, respectively. In the early era, 30-day mortality was higher in low-volume compared to high-volume hospitals (17% vs 9.68%, p=0.029), but not in the recent era (11.0% vs 13.4%, p=0.409). At low-volume hospitals, both 30-day and 1-year mortality were higher following concomitant TAVR Explant compared to isolated TAVR Explant (19.9% vs 9.3%, p<0.001; 25.4% vs 13.6%, p<0.001), but not in high-volume hospitals (14% vs 8.78%, p=0.148; 18.3% vs 15.5%, p=0.518). On multivariable analysis, high-volume hospital status was associated with lower mortality for the early era (OR 0.48 [CI 0.25-0.95]), but not for the recent era (OR 1.30 [CI 0.71-2.38]) or the overall cohort (OR 0.80 [CI 0.51-1.24]).

Conclusions: While hospital volume-outcome relationship to TAVR Explant mortality existed in the early era, recent data suggests no volume-outcome relationship. With the lack of a volume-outcome relationship, TAVR Explant will become a fundamental cardiac surgery. High-risk concomitant surgery may benefit from high-volume hospital management.