Are Outcomes of TAVR Better in Teaching Hospitals?

Transcatheter aortic valve replacement (TAVR) has become a cornerstone in the management of severe aortic stenosis. Large-scale nationwide data on factors impacting outcomes and complications of this new procedure, however, are sparse. In this month’s issue of the Journal of Invasive Cardiology, from a retrospective analysis using data from the Nationwide Inpatient Sample (NIS), the largest all-payer database of hospital inpatient stay available in the United States, we reported the impact of institutional design on TAVR outcome.(1)

Analysis of 7405 procedures performed throughout 2012 revealed that the majority of procedures were performed in teaching hospitals. While there was no difference in the in-hospital mortality, there was a statistically significant difference in the complication rates based on institutional design. Patients in teaching hospitals had fewer complication rates when compared with their counterparts in non-teaching hospital. Of note in the current study, the majority (88%) of these procedures were performed in teaching hospitals, hence it was hypothesized that teaching hospitals could be high-volume centers with operators gaining more experience in such settings, perhaps resulting in lower complication rates. While TAVR indications and utilization are expanding, it becomes important to understand the factors impacting the outcomes, risk mitigation strategy, and appropriate planning to maximize TAVR care and reduce cost. In an accompanying commentary, Balan et al provide an example of the “hub-and-spoke” model for TAVR care in British Columbia and how this approach helped maximize TAVR access in the region, yet maintained good outcomes.(2,3) While it’s not entirely fair to compare these two different healthcare systems, it is time to develop a model at the regional and national levels to provide competent and cost-effective TAVR care in the United States. We believe data from the TAVR registry may be a great resource in developing and monitoring such a system.

Sadip Pant, MD; University of Louisville School of Medicine, Louisville, KY

Kanishk Agnihotri, MD; Saint Peter’s University Hospital, Jersey City, NJ

Michael P. Flaherty, MD; University of Louisville School of Medicine, Louisville, KY

References
(1) Pant S, Patel S, Golwala H, et al. Transcatheter aortic valve replacement complication rates in teaching vs non-teaching centers in the United States. J Invasive Cardiol. 2016;28:67-70.
(2) Balan P, Anderson HV, Helmy T. How to Build a Better TAVR. J Invasive Cardiol. 2016;28:71-72.
(3) Stub D, Lauck S, Lee M, et al. Regional systems of care to optimize outcomes in patients undergoing transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2015;8:1944-1951.

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