TAVR site clusters could lead to drop in procedure quality, study suggests

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An August study published in the Journal of the American College of Cardiology suggests that an uneven distribution of sites performing transcatheter aortic valve replacements can lead to a drop in procedural quality.

Using data from the Transcatheter Valve Therapy registry, a tool used to monitor the safety and efficacy of TAVR procedures, researchers identified sites offering the procedure from 2011 to 2018 and calculated drive times from existing to new sites. They also examined each site’s case volume, site-to-population density and patient outcomes.

The study found that the number of TAVR sites increased from 198 in 2011 to 556 in 2018. The average drive time from existing to new sites decreased from 403 minutes in 2011 to 26 minutes in 2018. The results also showed that higher site density was associated with lower procedural risk, but an increased mortality risk.

Researchers concluded that the expansion of TAVR sites has led to regional clustering of these services, which could have "unintended consequences on procedural quality."

Lead author Javier Valle, MD, said that some procedural requirements were modified to expand services in rural areas, but that more data is needed to identify how to curb negative procedure outcomes, according to an Aug. 24 Cardiovascular Business article.

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