“There appears to be a ‘Halo Effect’ in hospitals with transcatheter aortic valve replacement (TAVR) programs,” said Vikas Singh, M.D., chief cardiology fellow, University of Miami Hospital. “Patients with aortic valve disease certainly benefit from better overall management of their condition in these hospitals, resulting in improved outcomes for conventional surgical aortic valve replacement (SAVR).”
Singh was lead author of the study published recently in the American Journal of Cardiology, “Comparison of Inhospital Outcomes of Surgical Aortic Valve Replacement in Hospitals With and Without Availability of a Transcatheter Aortic Valve Implantation Program (from a Nationally Representative Database).” There were 24 co-authors from 15 collaborative institutions, including Nileshkumar J. Patel, M.D., and Nish Patel, M.D., both cardiology fellows at the Miller School.
The comparative study focused on 9,674 conventional open heart SAVR replacement procedures performed on patients age 50 or above in 2011-2012. Nearly half of the procedures (47 percent) were performed at hospitals that also had TAVR programs, and 53 percent were in the non-TAVR group. The study found that in-hospital mortality was lower in the TAVR group (1.4 percent) than in the non-TAVR group (1.7 percent), as were complications (35.6 percent vs. 37.3 percent).
“Since the U.S. Food and Drug Administration approved TAVR for high-risk surgical patients with other serious conditions, the procedure has gained worldwide acceptance,” Singh said. “TAVR programs incorporate a complex decision-making process and active involvement of an integrated ‘Heart Team’ of physicians with diverse expertise, including interventional cardiologists, cardio-thoracic surgeons, anesthesiologists, echocardiographers and radiologists.”
Hospitals with TAVR programs also treat a higher volume of patients with aortic valve disease, Singh added. “This higher level of experience, plus the coordinated approach to managing patients with aortic stenosis are two keys to reducing mortality and complication rates with conventional surgery. The presence of a TAVR program clearly makes a significant difference to these cardiac patients.”
University of Miami,