Excluding TAVR patients with the highest risk did not improve hospital-level, risk-adjusted outcomes, according to a recent study published in Circulation: Cardiovascular Interventions.

Using data from the STS/ACC TVT Registry, Ahmed A. Kolkailah, MD, MSc, et al., included 43,907 patients (median age 79, 57% men, 93% White race) from 398 sites who underwent TAVR in 2021. They used simulation models to determine whether avoiding the top 10% highest-risk patients would impact hospital-level risk-adjusted outcomes. The study's primary outcome was a 30-day composite of death, stroke, VARC major/life-threatening/disabling bleeding, renal failure, or moderate/severe paravalvular leak.

Excluding the highest-risk patients did not result in a significant change to the hospital-level, risk-adjusted win ratio (mean difference 0.002±0.067; p=0.60).

The authors also investigated a secondary outcome of 30-day death, including 56,982 patients from 520 sites with available data. After excluding the highest-risk patients, no significant difference was found in their observed/expected ratios (mean difference –0.003±0.633; p=0.90).

"Although some centers improved their risk-adjusted outcomes, others fared worse with a strategy of systematic risk avoidance," write the authors. "These data provide reassurance that TAVR may be offered to all patients who are clinically indicated, including those at higher risk of complications, without the sole focus being on worsening hospitals' performance metrics."