Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
JACC Cardiovasc Interv. 2024 Feb 26;17(4):505-515. doi: 10.1016/j.jcin.2023.11.012. Epub 2024 Feb 7.
A single, multitiered valve center designation has been proposed to publicly identify centers with expertise for all valve therapies. The correlation between transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) procedures is unknown.
The authors sought to examine the relationship between site-level volumes and outcomes for TAVR and MTEER. We further explored variability between sites for MTEER outcomes.
Using the STS/ACC TVT (Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy) national registry, TAVR and MTEER procedures at sites offering both therapies from 2013 to 2022 were examined. Sites were ranked into deciles of adjusted in-hospital and 30-day outcomes separately for TAVR and MTEER and compared. Stepwise, hierarchical multivariable models were constructed for MTEER outcomes, and the median OR was calculated.
Between 2013 and 2022, 384,394 TAVRs and 53,274 MTEERs (median annualized volumes: 93.6 and 18.8, respectively) were performed across 453 U.S. sites. Annualized TAVR and MTEER volumes were moderately correlated (r = 0.48; P < 0.001). After adjustment, 14.3% of sites had the same decile rank for TAVR and MTEER 30-day composite outcome, 50.6% were within 2 decile ranks; 35% had more discordant outcomes for the 2 procedures (P = 0.0005). For MTEER procedures, the median OR for the 30-day composite outcome was 1.57 (95% CI: 1.51-1.64), indicating a 57% variability in outcome by site.
There is modest correlation between hospital-level volumes for TAVR and MTEER but low interprocedural correlation of outcomes. For similar patients, site-level variability for mortality/morbidity following MTEER was high. Factors influencing outcomes and "centers of excellence" as a whole may differ for TAVR and MTEER.
已经提出了一个单一的、多层次的瓣膜中心指定，以公开识别具有所有瓣膜治疗专业知识的中心。经导管主动脉瓣置换术（TAVR）和二尖瓣经导管缘对缘修复术（MTEER）之间的相关性尚不清楚。
作者试图研究 TAVR 和 MTEER 的术者水平容量与结局之间的关系。我们进一步探讨了 MTEER 结局在术者之间的变异性。
使用 STS/ACC TVT（胸外科医师学会/美国心脏病学会经导管瓣膜治疗）国家登记处，对 2013 年至 2022 年期间提供这两种治疗方法的术者进行了 TAVR 和 MTEER 手术检查。根据 TAVR 和 MTEER 的院内和 30 天调整结局，将术者分别分为十等份，并进行比较。逐步构建 MTEER 结局的分层多变量模型，并计算中位数比值比（OR）。
在 2013 年至 2022 年期间，美国 453 个术者进行了 384394 例 TAVR 和 53274 例 MTEER（年均手术量分别为 93.6 和 18.8）。TAVR 和 MTEER 的年均手术量呈中度相关（r=0.48；P<0.001）。经过调整，14.3%的术者 TAVR 和 MTEER 30 天复合结局的百分位排名相同，50.6%的术者在 2 个百分位排名内；35%的术者两种手术的结局更不一致（P=0.0005）。对于 MTEER 手术，30 天复合结局的中位数 OR 为 1.57（95%可信区间：1.51-1.64），表明术者之间的结局存在 57%的变异性。
TAVR 和 MTEER 的医院层面容量之间存在适度相关性，但手术结局之间的相关性较低。对于相似的患者，MTEER 术后死亡率/发病率的术者水平变异性很高。影响结局的因素以及作为一个整体的“卓越中心”可能因 TAVR 和 MTEER 而有所不同。
