Volume-outcome relationship of mortality following surgical explant of transcatheter aortic valve replacements.

Abstract

To evaluate the relationship between hospital volume of transcatheter aortic valve replacement (TAVR) explants and postoperative mortality. The Center for Medicare & Medicaid Services was queried from 2016 to 2024 for patients who underwent TAVR explant. The study period was divided into 2 eras: early (2016-2021) and recent (2022-2024). Hospitals were classified grouped as low volume or high volume. Both 30-day and 1-year mortality were compared, and multivariable analysis was performed. We identified a total of 123 TAVR explants during the study period. Of the 375 hospitals that performed at least 1 TAVR explant, 235 (63%) performed fewer than 3 explants. Postoperative mortality was 13.3% at 30 days and 18.3% at 1 year. Thirty-day mortality was higher in low-volume hospitals compared to high-volume hospitals in the early era (17% vs 9.68%; P = .029), but not in the recent era (11.0% vs 13.4%; P = .409). At low-volume hospitals, both 30-day and 1-year mortality were higher following concomitant TAVR explant compared to isolated TAVR explant (19.9% vs 9.3% [P < .001] and 25.4% vs 13.6% [P < .001], respectively), but not in high-volume hospitals (14% vs 8.78% [P = .148] and 18.3% vs 15.5% [P = .518], respectively). On multivariable analysis, high-volume hospital status was associated with lower mortality for the early era (odds ratio [OR], 0.48; 95% confidence interval [CI], 0.25-0.95), but not for the recent era (OR, 1.30; 95% CI, 0.71-2.38) or the total cohort (OR, 0.80; 95% CI, 0.51-1.24). While a hospital volume-outcome relationship to TAVR explant mortality existed in the early era, recent data suggest no volume-outcome relationship. With the lack of a volume-outcome relationship, TAVR explant will become a fundamental cardiac surgical procedure. High-risk concomitant surgery may benefit from high-volume hospital management.