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Original research
Outcomes of transcatheter aortic valve implantations in high-volume or low-volume centres in Germany
  1. Vera Oettinger1,
  2. Klaus Kaier2,
  3. Timo Heidt1,
  4. Markus Hortmann1,
  5. Dennis Wolf1,
  6. Andreas Zirlik3,
  7. Manfred Zehender1,
  8. Christoph Bode1,
  9. Constantin von zur Mühlen1,
  10. Peter Stachon1
  1. 1 Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany
  2. 2 Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
  3. 3 Clinical Department for Cardiology, Hospital of the Federal State of Styria and University Hospital Graz, Graz, Steiermark, Austria
  1. Correspondence to Dr Peter Stachon, Cardiology and Angiology I, University Heart Center Freiburg, Freiburg 79085, Germany; peter.stachon{at}universitaets-herzzentrum.de

Abstract

Objective Transcatheter aortic valve implantation (TAVI) is the most common aortic valve replacement in Germany. Since 2015, to ensure high-quality procedures, hospitals in Germany and other countries that meet the minimum requirement of 50 interventions per centre are being certified to perform TAVI. This study analyses the impact of these requirements on case number and in-hospital outcomes.

Methods All isolated TAVI procedures and in-hospital outcomes between 2008 and 2016 were identified by International Classification of Diseases (ICD) and the German Operation and Procedure Classification codes.

Results 73 467 isolated transfemoral and transapical TAVI procedures were performed in Germany between 2008 and 2016. During this period, the number of TAVI procedures per year rose steeply, whereas the overall rates of hospital mortality and complications declined. In 2008, the majority of procedures were performed in hospitals with fewer than 50 cases per year (54.63%). Until 2014, the share of patients treated in low-volume centres constantly decreased to 5.35%. After the revision of recommendations, it further declined to 1.99%. In the 2 years after the introduction of the minimum requirements on case numbers, patients were at decreased risk for in-hospital mortality when treated in a high-volume centre (risk-adjusted OR 0.62, p=0.012). The risk for other in-hospital outcomes (stroke, permanent pacemaker implantation and bleeding events) did not differ after risk adjustment (p=0.346, p=0.142 and p=0.633).

Conclusion A minimum volume of 50 procedures per centre and year appears suitable to allow for sufficient routine and thus better in-hospital outcomes, while ensuring nationwide coverage of TAVI procedures.

  • transcatheter valve interventions
  • valvular heart disease
  • aortic regurgitation

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Footnotes

  • Contributors VO: substantial contributions to the conception and design of the work, and acquisition, analysis or interpretation of data; drafting the work and revising it critically for important intellectual content. KK: conception or design of the work, and acquisition, statistical analysis and interpretation of data; revision of the manuscript and final approval. TH: conception of the study, interpretation and final approval. MH: conception of the study, statistical analysis and interpretation. DW: conception of the study, interpretation and final approval. AZ: conception of the study, interpretation and final approval. MZ: supervision, conception of the study, interpretation and final approval. CB: supervision, conception of the study, interpretation and final approval. CvzM: supervision, conception of the study, interpretation and final approval. PS: supervision, substantial contribution to the conception and design of the work, and acquisition, analysis or interpretation of data; drafting the work and revising it critically for important intellectual content. PS and CvzM share the last authorship.

  • Funding This work was supported by an internal funding from University Heart Center Freiburg.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Our study did not involve direct access to data on individual patients but only access to summary results provided by the Research Data Center. Therefore, approval by an ethics committee and informed consent were determined not to be required, in accordance with German law.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The patients’ data are stored on the server of the Federal Bureau of Statistics and are not available due to data protection. The calculated raw data are sent anonymised to the scientist.

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