A study revealed that hospitals which perform the topmost number of Trans Catheter-Aortic Valve Replacement (TAVR) procedures have lesser number of dying patients than those that centers that focus on insignificant invasive surgeries. The findings were published in the “New England Journal of Medicine”
Lead author, Sreekanth Vemulapalli said: “What we found is that there is still a very real relationship with annual volume and 30-day mortality at the hospital level, even taking into account the new devices and the learning curve that new centers face in the first 12 months of initiating a program.”
He further added: “TAVR is different from most other cardiac procedures – it’s not a single-person effort. The procedure involves putting a replacement valve over a damaged aortic valve using a catheter rather than open-chest surgery, similar to the way a stent is placed in coronary arteries. Patients are evaluated by a surgeon and an interventional cardiologist, and there is usually also a cardiac imaging specialist involved in the procedure. That team approach is very important, which is why we looked at the data from a hospital level.”
Last summer Vemulapalli along with his team launched their research after the announcement of CMS about its reevaluation of coverage criteria. They used Transcatheter Valve Register; a database, to focus on the volumes & results from 2015 to 2017. They extracted the first 12 cases of a hospital to interpret the learning curve. Nearly five hundred were included and were further categorized into 4 groups on the basis of their volume.
M.D, John Carrol stated: “This was the most comprehensive analysis of the outcomes of more than 100,000 people recently receiving TAVR in the U.S. The results definitively reaffirm an inverse relationship between the volume of procedures and the risk of death following the procedure.”
The co-author of this research, Micahel Mack said: “These findings suggest a clear relationship between the volume of TAVR procedures and death at 30 days, both at the hospital level and at the individual operator level, and should be factored into the CMS revised National Coverage Determination related to TAVR until a validated quality outcome metric can be established. This relationship held true even after eliminating the first 12 months, meaning this is not just a ‘learning curve.’”