Hogere ziekenhuisvolumes verbeteren efficiëntie bij transcarotide TAVR — maar mortaliteit blijft gelijk

BACKGROUND: When transfemoral transcatheter aortic valve replacement (TAVR) is unsuitable, transcarotid TAVR offers a safe alternative. The relationship between hospital procedural volume and clinical outcomes remains unclear, and solidifying this relationship is key to establishing benchmarks and guiding high-quality care. METHODS: We retrospectively analyzed US academic centers in the Vizient Clinical Database, a national repository of tertiary and quaternary hospital data. All centers performing transcarotid TAVR in 2022 to 2024 were included. Patient demographics and outcomes were compared using the Kruskal-Wallis and χ2 tests. Spearman rank correlation was used to assess hospital volume and outcome associations. RESULTS: Between 2022 and 2024, 118 academic hospitals performed 10,394 transcarotid TAVR procedures. Institutions were stratified by 3-year cumulative procedural volume: Q1, 15 to 47 cases (n = 87); Q2, 48 to 77 (n = 87); Q3, 78 to 111 (n = 90); and Q4, 112 to 312 (n = 90). High-volume centers treated older patients (71 years vs 69 years), a higher proportion of white patients (85.4% vs 64.5%), more Medicare beneficiaries (72.4% vs 62.8%), and patients with lower case complexity (Case Mix Index, 2.6 vs 3.5) (P < .0001 for all). Observed hospital length of stay (LOS) decreased across quartiles (7.5 to 4.9 days), and intensive care unit admission declined (70.7% to 42.5%) (all P < .0001). Observed mortality and mortality index did not differ significantly (all P > .05). Spearman correlation analysis showed weak associations between higher volume and shorter LOS or lower case complexity, with very weak and inconsistent correlations for mortality. CONCLUSIONS: Higher hospital transcarotid TAVR volume is associated with greater resource efficiency, likely attributable in part to lower patient complexity. Mortality and complication outcomes were roughly comparable between transcarotid and transfemoral TAVR, suggesting comparable short-term safety across institutions.