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Thorac Cardiovasc Surg 2024; 72(03): 173-180
DOI: 10.1055/s-0042-1754352
Original Cardiovascular

Impact of Procedure Volume on the Outcomes of Surgical Aortic Valve Replacement

Vera Oettinger 
1   Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
2   Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Klaus Kaier
2   Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
3   Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center – University of Freiburg, Freiburg, Germany
,
Constantin von zur Mühlen
1   Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
2   Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Manfred Zehender
1   Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
2   Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Christoph Bode
1   Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Friedhelm Beyersdorf
4   Department of Cardiac and Vascular Surgery, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Peter Stachon   *
1   Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
2   Center for Big Data Analysis in Cardiology (CeBAC), Department of Cardiology and Angiology I, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
,
Wolfgang Bothe   *
4   Department of Cardiac and Vascular Surgery, University Heart Center Freiburg, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
› Author Affiliations Funding This work was supported by the “German Heart Foundation/German Foundation of Heart Research.”
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Abstract

Background Literature demonstrated that procedure volumes affect outcomes of patients undergoing transcatheter aortic valve implantation. We evaluated the outcomes of surgical aortic valve replacement.

Methods All isolated surgical aortic valve replacement procedures in Germany in 2017 were identified. Hospitals were divided into five groups from ≤25 (very low volume) until >100 (very high volume) annual procedures.

Results In 2017, 5,533 patients underwent isolated surgical aortic valve replacement. All groups were of comparable risk (logistic EuroSCORE, 5.12–4.80%) and age (66.6–68.1 years). In-hospital mortality and complication rates were lowest in the very high-volume group. Multivariable logistic regression analyses showed no significant volume–outcome relationship for in-hospital mortality, stroke, postoperative delirium, and mechanical ventilation > 48 hours. Regarding acute kidney injury, patients in the very high-volume group were at lower risk than those in the very low volume group (odds ratio [OR] = 0.53, p = 0.04). Risk factors for in-hospital mortality were previous cardiac surgery (OR = 5.75, p < 0.001), high-grade renal disease (glomerular filtration rate < 15 mL/min, OR = 5.61, p = 0.002), surgery in emergency cases (OR = 2.71, p = 0.002), and higher grade heart failure (NYHA [New York Heart Association] III/IV; OR = 1.80, p = 0.02). Risk factors for all four complication rates were atrial fibrillation and diabetes mellitus.

Conclusion Patients treated in very low volume centers (≤25 operations/year) had a similar risk regarding in-hospital mortality and most complications compared with very high-volume centers (>100 operations/year). Only in the case of acute kidney injury, very high-volume centers showed better outcomes than very low volume centers. Therefore, surgical aortic valve replacement can be performed safely independent of case volume.

Keywords

surgical aortic valve replacement - volume–outcome relationship - caseload - in-hospital mortality - complications - transcatheter aortic valve implantation

Note

This article was presented at the 87th Annual Meeting of the German Cardiac Society (DGK), Congress Center Rosengarten Mannheim, Rosengartenplatz 2, 68161 Mann-heim, Germany, online, April 7–10, 2021.


Ethical Approval Statement

Our study did not involve direct access by the investigators 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. All summary results were anonymized by DESTATIS. In practice, this means that any information allowing the drawing of conclusions about a single patient or a specific hospital was censored by DESTATIS to guarantee data protection. Moreover, to prevent the possibility to draw conclusions to a single hospital, the data are verified and situationally censored by DESTATIS in those cases.


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 anonymized to the scientist.


* These authors share the last authorship.


Supplementary Material



Publication History

Received: 09 November 2021

Accepted: 14 March 2022

Article published online:
02 August 2022

© 2022. Thieme. All rights reserved.

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