The Relation Between Hospital Transcatheter Aortic Valve Replacement Volume and Transcatheter Edge-to-Edge Repair Outcomes: A Study Using the National Readmissions Database

Volume-outcome relations exist for transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (TEER), but how the volume of one impacts the outcomes of the other has not been studied. We, therefore, examined the association between TAVR volume and TEER outcomes using patients who underwent TEER in the Nationwide Readmissions Database from 2016 to 2018. For each year, hospitals were categorized into quartiles (first = lowest volume, fourth = highest volume) by TAVR volume. The primary outcomes for TEER, including 30-day composite mortality and morbidity and 30-day readmissions, were compared between TAVR volume quartiles before and after adjustment. Overall, 16,156 patients who underwent TEER were included: 209 at hospitals in the first, 1,094 at hospitals in the second, 3,363 at hospitals in the third, and 11,490 at hospitals fourth quartile by TAVR volume. There were no significant differences in observed in the 30-day composite morbidity and mortality (41.0% vs 26.1% vs 28.2% vs 28.3%, p = 0.063) or 30-day readmissions (14.8% vs 14.1% vs 14.8% vs 15.0%, p = 0.920) across the first through fourth quartiles. The adjusted results revealed that TEER performed at hospitals in the second through fourth quartiles by TAVR volume had significantly lower odds of 30-day composite morbidity and mortality in 2016 (adjusted odds ratio 0.41 [019 to 0.85], 0.32 [0.18 to 0.57], and 0.35 [0.20 to 0.62]) and 2018 (adjusted odds ratio 0.55 [0.31 to 0.96], 0.53 [0.33 to 0.84], and 0.59 [0.38 to 0.91]) relative to TEER at hospitals in the lowest TAVR volume quartile (all p <0.05). In conclusion, the lowest volume TAVR centers are associated with increased morbidity and mortality after TEER. Therefore, a minimum TAVR volume cutoff may guide the designation of TEER centers and Valve Centers of Excellence.