Volume-outcome relationship with transfemoral transcatheter aortic valve implantation (TAVI): insights from the compulsory German Quality Assurance Registry on Aortic Valve Replacement (AQUA)

Bestehorn, Kurt; Eggebrecht, Holger; Fleck, Eckart; Bestehorn, Maike; Mehta, Rajendra H.; Kück, Karl‐Heinz

doi:10.4244/eij-d-17-00062

Cited by 47 publications

(21 citation statements)

References 16 publications

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“…Recent studies report excellent outcome with a “minimalist” approach 15 ; even next‐day discharge in lower‐risk patients is a safe possibility 16 . Studies have reported an important volume‐outcome relationship with TAVR 17,18 which further supports our findings as average volume between centers were comparable.…”

Section: Discussionsupporting

confidence: 88%

Safety‐net hospitals versus non‐safety centers and clinical outcomes after trans‐catheter aortic valve replacement

Sheikh

Deo

Riaz

et al. 2020

Cathet Cardio Intervent

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Objective To compare post‐procedural outcomes of trans‐catheter valve replacement (TAVR) among safety‐net (SNH) and non‐safety net hospitals (non‐SNH). Background SNH treat a large population of un‐insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. Methods Adults undergoing TAVR at hospitals in the US participating in the National In‐patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity‐matched cohort of patients operated at SNH and non‐SNH institutions was analyzed, on the basis of 16 demographic and clinical co‐variates. Main outcome was all‐cause post‐procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post‐operative stay. Results Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity‐matched patient pairs. Post‐procedural mortality [OR 0.99(0.98–1.007); p = .43], stroke [OR 1.009(0.99–1.02); p = .08], acute kidney injury [OR 0.99(0.96–1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. Conclusion Post‐procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.

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Section: Discussionsupporting

confidence: 88%

Safety‐net hospitals versus non‐safety centers and clinical outcomes after trans‐catheter aortic valve replacement

Sheikh

Deo

Riaz

et al. 2020

Cathet Cardio Intervent

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“…Length of stay was similar to that of femoral TAVR from previous studies 33‐36 . However, the study looking at Transcatheter Valve Therapy Registry from 2011 to 2015 with 13,389 femoral TAVR patients found that there has been a significant decline in the rates of delayed discharge across all the risk groups 37 .…”

Section: Discussionsupporting

confidence: 72%

Carotid access for transcatheter aortic valve replacement: A meta‐analysis

Sharma

Chaudhary

Ghuneim

et al. 2020

Cathet Cardio Intervent

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Objective We sought to evaluate the feasibility and safety of carotid access transcatheter aortic valve replacement (TAVR) by performing a meta‐analysis of published cases. Background Several case series and regional data have provided initial basis for carotid access TAVR in patients with prohibitive femoral approach. We performed this meta‐analysis to provide further evidence of feasibility and safety of carotid TAVR. Methods We searched PubMed, EMBASE, CINAHL, and Cochrane CENTRAL for any study on carotid access TAVR involving ⩾5 patients since inception till March 1, 2020. Random‐effects model was used to compute overall effects. The outcomes analyzed were all‐cause mortality, Transient ischemic attack (TIA)/stroke, need for permanent pacemaker (PPM) implantation, pericardial tamponade, access site complications, major bleeding, and length of stay. Results There was a total of 17 retrospective studies (n = 2082) with a median follow‐up of 1 month. Mean age of the patient was 80 years. Mean Euroscore and STS scores were 15 ± 6.2 and 7.9 ± 3.3, respectively. The procedural success rate was 99%. The rate of all‐cause mortality was 6.7% (range 4.6–9.7%, p < .001, I2 = 67%). Incidence of TIA/stroke was 3.9% (range 3.1–4.8%, p < .001, I2 = 0%) and PPM implantation was 16.7% (range 12.5–21.9%, p < .001, I2 = 56%). Rate of pericardial tamponade, vascular complication, and major bleeding were 1.7, 2.5, and 7%, respectively. Average length of hospital stay was 7.7 days. Conclusion Our results show that transcarotid approach is a feasible option in patients with prohibitive femoral access for TAVR.

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“…Replacement. Six studies [6][7][8][9][10][11] comprising 115,596 patients were included and had a population period ranging from 2005 to 2016; three were from the U.S., two were from Germany, and the last one analyzed patients from South and North America and Europe. Two studies used clinical data; the rest used less evidenced administrative data.…”

Section: Transcatheter Aortic Valvementioning

confidence: 99%

The Relation between Volume and Outcome of Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Zhang

Wang

et al. 2020

Cardiovascular Therapeutics

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Transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) are standard procedures for dealing with severe aortic stenosis patients. Researchers have not carried out a systematic review of the volume-outcome relationship in TAVR and SAVR. Our study is intended to address this problem. We systemically searched databases through MEDLINE, EMBASE, PUBMED, and the Cochrane Library up to September 2019. Two reviewers independently screened for the studies and evaluated bias. We used short-term mortality (in-hospital or 30-day mortality) as an outcome. A meta-analysis of TAVR with 115,596 patients ranging from 2005 to 2016 showed a result significantly in favor of high-volume hospitals (OR 0.43 (CI 0.36-0.51)). The subgroup of population period, region, data type, and cut-off value did not show any difference. A meta-analysis of SAVR comprising 418,384 patients ranging from 1994 to 2011 revealed that the OR of short-term mortality for a high-volume hospital compared with that of a low-volume hospital was 0.73 (CI 0.71, 0.74). No difference was observed in subgroups based on population period and cut-off. In conclusion, we found that short-term mortality was lower in high-volume hospitals for both TAVR and SAVR.

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Volume-outcome relationship with transfemoral transcatheter aortic valve implantation (TAVI): insights from the compulsory German Quality Assurance Registry on Aortic Valve Replacement (AQUA)

Abstract: Across the spectrum of hospital volumes from 11 to 415 patients undergoing TF-TAVI per year in Germany, there was a continuous, statistically significant association of lower average observed as well as risk-adjusted in-hospital mortality with increasing TF-TAVI volumes.

Cited by 47 publications

References 16 publications

Safety‐net hospitals versus non‐safety centers and clinical outcomes after trans‐catheter aortic valve replacement

Safety‐net hospitals versus non‐safety centers and clinical outcomes after trans‐catheter aortic valve replacement

Carotid access for transcatheter aortic valve replacement: A meta‐analysis

The Relation between Volume and Outcome of Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis

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