Abstract 14989: Failure to Rescue After Transcatheter Aortic Valve Replacement: Does Experience Matter?

Abstract

Introduction: Volume-outcome relationships are well defined in transcatheter aortic valve replacement (TAVR), but little is known about how hospital experience in aortic valve replacement (AVR) informs processes of care to rescue patients once a complication occurs after TAVR. Hypothesis: Increasing AVR experience improves post-TAVR rates of failure to rescue (FTR) - defined as in-hospital mortality after major treatable post-procedural complications. Methods: Statewide Inpatient Databases from seven diverse states were queried from 2011 to 2017 for patients who underwent TAVR. Hospitals were stratified as low vs high-volume by mean annualized SAVR and TAVR volume using the median as cutoff: SAVR = 43 cases/year, TAVR = 28 cases/year. Crude rates of complications, in-hospital mortality, and FTR were estimated for the overall sample and stratified by SAVR and TAVR volume (low vs high). Logistic regression was used to estimate the adjusted odds ratio of SAVR and TAVR volume, independently, on the outcomes above, adjusting for patient demographics and comorbid conditions. Results: A total of 42,025 TAVR patients were identified and categorized as low (N = 2,946) or high-volume (N = 39,079) SAVR centers, and low (N = 7,183) or high-volume (N = 34,842) TAVR centers. Within the high-volume SAVR centers, 84.8% were also high-volume TAVR centers. Low SAVR or TAVR volume was associated with a marginal increase in the risk of developing complications after TAVR (OR 1.26; P < 0.001 and OR 1.14; P < 0.001) as show in Table 1. There was no statistically significant difference in risk-adjusted in-hospital mortality rates (OR 1.10; P = 0.499 and OR 1.10; P = 0.273) or FTR rates (OR 0.97; P = 0.816 and OR 1.03; P = 0.732) after TAVR between low- and high-volume SAVR or TAVR centers, respectively. Conclusion: Undergoing TAVR at a high-volume SAVR or TAVR center was associated with lower rates of complications, but volume was not an independent predictor of in-hospital mortality or FTR.