Impact of surgical aortic valve and coronary intervention volume on transcatheter aortic valve replacement outcomes

Background: Transcatheter aortic valve replacement (TAVR) centers must meet specific volume criteria. This study aimed to examine whether hospital surgical aortic valve replacement (SAVR) and percutaneous coronary intervention (PCI) volumes are associated with early TAVR outcomes.

Methods: We analyzed TAVR hospitalizations from the Hospital Quality Monitoring System in China (2016–2021). Hospitals were categorized into low- or high-volume centers based on the mean annual number of SAVR or PCI procedures. A case-sequence approach and multivariate regressions were used to evaluate the impact of high-volume status on in-hospital death or discharge against medical advice (DAMA) following TAVR.

Results: Between 2016 and 2021, a total of 12,823 TAVR procedures were performed at 461 hospitals, with 8,314 selected for analysis. From the first to the 125th case in the volume-outcome model, there was a reduced risk-adjusted rate of in-hospital death or DAMA. Low hospital SAVR volume (<40 procedures/year) was associated with a higher in-hospital death or DAMA rate after TAVR. In contrast, low PCI volume (<300 procedures/year) did not significantly affect outcomes. The beneficial effect of high SAVR volume on TAVR outcomes remained consistent across different cut-off points for high- and low-volume hospitals, with favorable effects observed between 15.5 and 107 SAVR procedures per year.

Conclusions: High hospital SAVR volume was associated with better outcomes in early TAVR cases. However, higher PCI volumes were not linked to lower mortality rates after early TAVR. Adequate SAVR experience is crucial for hospitals planning to establish new TAVR programs.

Keywords: Transcatheter aortic valve replacement (TAVR); surgical aortic valve replacement (SAVR); percutaneous coronary intervention (PCI); volume-outcome association; mortality rates


 

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Key findings

• High hospital surgical aortic valve replacement (SAVR) volume is linked to better early Transcatheter aortic valve replacement (TAVR) outcomes.

What is known and what is new?

• Previous studies have consistently demonstrated that higher institutional TAVR volumes are associated with improved patient outcomes, including fewer postoperative complications and lower in-hospital mortality.

• This study found that institutional SAVR experience also plays a significant role in influencing TAVR outcomes, particularly in hospitals with limited TAVR caseloads. Establishing a minimum threshold for SAVR volume may help improve the safety and effectiveness of TAVR programs, especially in developing countries where TAVR programs are still maturing.

What is the implication, and what should change now?

• Improving SAVR proficiency significantly impacts TAVR outcomes, especially in institutions with limited TAVR experience.

• Enhancing medical care quality can optimize TAVR performance in low-volume SAVR institutions.

Cite this article as: Zhang S, Hu S, Zheng Z, Rao C. Impact of surgical aortic valve and coronary intervention volume on transcatheter aortic valve replacement outcomes. J Thorac Dis 2025;17(10):8085-8093. doi: 10.21037/jtd-2025-802