Higher annualized TAVR volume is associated with lower complication rates but not with lower failure to rescue (FTR) rates, according to a recent study published in JACC: Cardiovascular Interventions.

Including 487,159 patients (median age, 79 years, 57% male) across 808 sites from the STS/ACC TVT Registry, Tayyab Shah, MD, et al., evaluated the risk of major complications and FTR, defined as 30-day risk-adjusted mortality following a major complication post TAVR, by annualized TAVR volume.

Lower volume sites exhibited significantly higher 30-day mortality (adjusted OR, 1.12; 95% CI, 1.00-1.25; p=0.045) and major complications (adjusted OR, 1.19; 95% CI, 1.08-1.32; p=0.0006) when compared with higher volume sites.

However, no significant difference in FTR was observed across sites of varying procedure volume (adjusted OR, 0.97 per 100 cases; 95% CI, 0.93-1.01; p=0.11) with no evidence of a threshold relationship. The overall FTR rate was 11%.

"These findings suggest that future quality improvement efforts, particularly at low-volume centers, may be higher yield if they prioritize reducing complication rates rather than devoting resources to systems to rescue patients from rare but catastrophic complications with a low likelihood of successful rescue, even at high-volume centers," write the authors.

According to an accompanying editorial comment, Zaid I. Almarzooq, MD, MPH, and Jay Khambhati, MD, FACC, call this analysis "an important step forward in understanding the volume-outcome curve in contemporary TAVR, and it provides a useful reframing of the institutional volume-mortality question into its complication and rescue components."