Importance: Hospital outcomes for transcatheter aortic valve replacement (TAVR) may be dependent on the quality of evaluation, personnel, and procedural and postprocedural care common to patients undergoing cardiac surgery. Objectives: We sought to assess whether those hospitals with better patient outcomes for surgical aortic valve replacement (SAVR) subsequently achieved better TAVR outcomes after launching TAVR programs. Design, Setting, and Participants: This national cohort included US patients 65 years and older. The analysis used the Centers for Medicare and Medicaid Services' Medicare Provider and Review data collected between January 1, 2010, and September 29, 2015. Only hospitals performing at least 1 SAVR prior to September 1, 2011, and performing at least 1 TAVR after this date were included in the analysis. Data analysis was completed from June 2018 to August 2018. Interventions: Isolated aortic valve replacements. Main Outcomes and Measures: Hospital risk-adjusted 30-day mortality for SAVR in the pre-TAVR period was used as a surrogate for SAVR quality. Thirty-day and 1-year TAVR mortality rates were examined after stratification by quartile of baseline hospital risk-adjusted SAVR mortality. Results: A total of 51 924 TAVR procedures were performed in 519 hospitals, of which 19 798 were performed at hospitals in quartile 1 (the lowest risk-adjusted SAVR mortality rate), 7663 were performed in quartile 2, 10 180 were performed in quartile 3, and 14 283 were performed in quartile 4 (the highest risk-adjusted SAVR mortality rate). Observed mortality rates at 30 days consistently increased with increasing baseline hospital SAVR risk-adjusted mortality (quartile 1, 917 patients [4.6%]; quartile 2, 381 [5.0%]; quartile 3, 521 [5.1%]; quartile 4, 800 [5.6%]; P < .001). The same pattern was observed in 1-year mortality (quartile 1, 3359 [17.0%]; quartile 2, 1337 [17.5%]; quartile 3, 1852 [18.2%]; quartile 4, 2652 [18.6%]; P < .001). After multivariable analysis, compared with the lowest quartile of SAVR mortality, undergoing TAVR at a hospital with higher baseline SAVR mortality continued to be associated with higher 30-day mortality (odds ratios: quartile 2, 1.02 [95% CI, 0.87-1.21]; quartile 3, 1.13 [95% CI, 1.02-1.26]; quartile 4, 1.23 [95% CI, 1.07-1.40]; P = .02) and 1-year mortality (hazard ratios: quartile 2, 1.04 [95% CI, 0.92-1.17]; quartile 3, 1.14 [95% CI, 1.02-1.28]; quartile 4, 1.16 [95% CI, 1.05-1.28]; P = .02). Conclusions and Relevance: Hospitals with higher SAVR mortality rates also had higher short-term and long-term TAVR mortality after initiating TAVR programs. Quality of cardiac surgical care may be associated with a hospital's performance with new structural heart disease programs.
Importance: Hospital outcomes for transcatheter aortic valve replacement (TAVR) may be dependent on the quality of evaluation, personnel, and procedural and postprocedural care common to patients undergoing cardiac surgery. Objectives: We sought to assess whether those hospitals with better patient outcomes for surgical aortic valve replacement (SAVR) subsequently achieved better TAVR outcomes after launching TAVR programs. Design, Setting, and Participants: This national cohort included US patients 65 years and older. The analysis used the Centers for Medicare and Medicaid Services' Medicare Provider and Review data collected between January 1, 2010, and September 29, 2015. Only hospitals performing at least 1 SAVR prior to September 1, 2011, and performing at least 1 TAVR after this date were included in the analysis. Data analysis was completed from June 2018 to August 2018. Interventions: Isolated aortic valve replacements. Main Outcomes and Measures: Hospital risk-adjusted 30-day mortality for SAVR in the pre-TAVR period was used as a surrogate for SAVR quality. Thirty-day and 1-year TAVR mortality rates were examined after stratification by quartile of baseline hospital risk-adjusted SAVR mortality. Results: A total of 51 924 TAVR procedures were performed in 519 hospitals, of which 19 798 were performed at hospitals in quartile 1 (the lowest risk-adjusted SAVR mortality rate), 7663 were performed in quartile 2, 10 180 were performed in quartile 3, and 14 283 were performed in quartile 4 (the highest risk-adjusted SAVR mortality rate). Observed mortality rates at 30 days consistently increased with increasing baseline hospital SAVR risk-adjusted mortality (quartile 1, 917 patients [4.6%]; quartile 2, 381 [5.0%]; quartile 3, 521 [5.1%]; quartile 4, 800 [5.6%]; P < .001). The same pattern was observed in 1-year mortality (quartile 1, 3359 [17.0%]; quartile 2, 1337 [17.5%]; quartile 3, 1852 [18.2%]; quartile 4, 2652 [18.6%]; P < .001). After multivariable analysis, compared with the lowest quartile of SAVR mortality, undergoing TAVR at a hospital with higher baseline SAVR mortality continued to be associated with higher 30-day mortality (odds ratios: quartile 2, 1.02 [95% CI, 0.87-1.21]; quartile 3, 1.13 [95% CI, 1.02-1.26]; quartile 4, 1.23 [95% CI, 1.07-1.40]; P = .02) and 1-year mortality (hazard ratios: quartile 2, 1.04 [95% CI, 0.92-1.17]; quartile 3, 1.14 [95% CI, 1.02-1.28]; quartile 4, 1.16 [95% CI, 1.05-1.28]; P = .02). Conclusions and Relevance: Hospitals with higher SAVR mortality rates also had higher short-term and long-term TAVR mortality after initiating TAVR programs. Quality of cardiac surgical care may be associated with a hospital's performance with new structural heart disease programs.
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Authors: Michael J Mack; Martin B Leon; Craig R Smith; D Craig Miller; Jeffrey W Moses; E Murat Tuzcu; John G Webb; Pamela S Douglas; William N Anderson; Eugene H Blackstone; Susheel K Kodali; Raj R Makkar; Gregory P Fontana; Samir Kapadia; Joseph Bavaria; Rebecca T Hahn; Vinod H Thourani; Vasilis Babaliaros; Augusto Pichard; Howard C Herrmann; David L Brown; Mathew Williams; Jodi Akin; Michael J Davidson; Lars G Svensson Journal: Lancet Date: 2015-03-15 Impact factor: 79.321
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Authors: Suzanne J Baron; Suzanne V Arnold; Kaijun Wang; Elizabeth A Magnuson; Khaja Chinnakondepali; Raj Makkar; Howard C Herrmann; Susheel Kodali; Vinod H Thourani; Samir Kapadia; Lars Svensson; David L Brown; Michael J Mack; Craig R Smith; Martin B Leon; David J Cohen Journal: JAMA Cardiol Date: 2017-08-01 Impact factor: 14.676
Authors: Marc L Schermerhorn; Dominique B Buck; A James O'Malley; Thomas Curran; John C McCallum; Jeremy Darling; Bruce E Landon Journal: N Engl J Med Date: 2015-07-23 Impact factor: 91.245
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Authors: Harun Kundi; Kamil F Faridi; Yun Wang; Rishi K Wadhera; Linda R Valsdottir; Jeffrey J Popma; Daniel B Kramer; Robert W Yeh Journal: Circulation Date: 2019-09-09 Impact factor: 29.690
Authors: Michael M Hammond; Changyu Shen; Stephanie Li; Dhruv S Kazi; Marwa A Sabe; A Reshad Garan; Lawrence J Markson; Warren J Manning; Allan L Klein; Sherif F Nagueh; Jordan B Strom Journal: PLoS One Date: 2020-12-22 Impact factor: 3.240
Authors: Godly Jack; Sameer Arora; Paula D Strassle; Kranthi Sitammagari; Kishorbhai Gangani; Michael Yeung; Matthew A Cavender; Patrick T O'Gara; John P Vavalle Journal: J Am Heart Assoc Date: 2019-11-13 Impact factor: 5.501