Aortic Valve (TAVR/TAVI)JACC:CITuesday, July 14, 2026

Hospital Volume and Failure to Rescue Post-TAVR: Insights From the STS/ACC TVT Registry.

1 min read·By E. Nolan Beckett, MD·Source: JACC. Cardiovascular interventions

Key Numbers

57% male

95% CI

11.0%

P = 0.045

From The Valve Wire

The volume-outcome debate in TAVR just shifted from "get more reps" to "prevent the complication in the first place." The STS/ACC TVT Registry analysis of 487,159 patients across 808 US sites (2017–2023) found bottom-quartile centers had 12% higher 30-day mortality (aOR 1.12) and 19% higher major complication rates than top-quartile centers, but failure-to-rescue was flat at ~11% across all volume strata.

The editorial companion framed this as "complications, not rescue" — meaning the CMS volume threshold debate should focus on procedural technique, patient selection, and CT planning, not ICU heroics after things go wrong.

Editor’s take pending for this article; this is the section commentary excerpt.

Source Abstract

BACKGROUND: There is an inverse volume-mortality relationship for transcatheter aortic valve replacement (TAVR), with higher adjusted mortality among hospitals with lower TAVR volumes. OBJECTIVES: The aim of this study was to identify potential mediators of the volume-mortality relationship including the risk of major complications occurring and/or failure to rescue (FTR) from these complications. METHODS: Using the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry, we identified patients who underwent TAVR from 2017 to 2023. The rate of FTR-defined as 30-day risk-adjusted mortality following a major complication post TAVR-was compared across hospitals stratified by quartiles (Q1-Q4) of annualized TAVR volume. RESULTS: A total of 487,159 patients (median age: 79 years, 57% male) who underwent TAVR across 808 sites were included. Lower-volume centers (Q1) had significantly higher rates of 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) than higher-volume centers (Q4). The overall rate of FTR across all hospitals was 11.0%. There were no significant differences in FTR rates by hospital volume (adjusted OR: 0.97 per 100 cases; 95% CI: 0.93-1.01; P = 0.11) and no evidence of a threshold relationship. CONCLUSIONS: In this large contemporary study, we found that higher annualized TAVR volume was associated with lower complication rates but not with lower FTR rates. These findings suggest that the inverse relationship between hospital TAVR volume and post-TAVR mortality may be more strongly associated with complication rates than with FTR.

Authors: Shah T, Sreenivasan J, Shah M, Kosinski A, Vemulapalli S et al.

Read the Original

Full article at JACC. Cardiovascular interventions

Open at JACC. Cardiovascular interventions →

The Valve Wire summarizes; we link out to primary sources for verification.