National Variation in Hospital MTEER Outcomes and Correlation With TAVR Outcomes: STS/ACC TVT Registry Analysis.

Background: 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.

Objectives: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Competing Interests: Funding Support and Author Disclosures Dr Kumbhani has received honoraria from the American College of Cardiology and the American Heart Association. Dr Chhatriwalla has served on Speakers Bureau for Abbott Vascular, Edwards Lifesciences, and Medtronic Inc; has been a proctor for Edwards Lifesciences and Medtronic Inc; and has received research support from Boston Scientific. Dr Giri has received institutional research funds and served on advisory boards for Boston Scientific, Abiomed, Recor Medical, Inari Medical, AstraZeneca, and Abbott Vascular. Dr Mack served as Trial Co-PI for Edwards Lifesciences and Abbott and Study Chair for Medtronic. Dr Carroll has served as a local site investigator in multicenter clinical trials sponsored by Medtronic, Abbott, and Edwards Lifesciences; and has served as a consultant and on advisory boards, and received honoraria from Edwards Lifesciences and Abbott. Dr Vemulapalli has received grants/contracts from the American College of Cardiology, Society of Thoracic Surgeons, Abbott Vascular, Cytokinetics, and the National Institutes of Health; and has served as a consultant and on advisory boards, and received honoraria from Medtronic, Edwards Lifesciences, and the American College of Physicians. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

(Copyright © 2024 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)