Surgical Aortic Valve Replacement Outcomes in Non-TAVR Centers - Implications to Tier-Based Systems of Care.

Abstract Background With wide expansion of Transcatheter aortic valve replacement (TAVR) and dissemination of multidisciplinary-based approaches to care, societies are discussing the implementation of a Tier-system to valve centers. This study explores the impact of Tier-based systems of care on Surgical AVR (SAVR) outcomes at institutions that perform SAVR only. Methods Medicare beneficiaries undergoing SAVR procedures from 2012 – 2015 were included. SAVR Hospitals were stratified into either Tier A, valve centers with a TAVR program, and Tier B, valve centers without a TAVR program. Adjusted survival, assessed by multivariable Cox regression, controlled for program type and patient risk-profile. Time-dependent analysis accounted for hospitals that initiated a TAVR program during the study period. Results Overall, there were 562 Tier A and 485 Tier B SAVR hospitals. Tier A hospitals had significantly higher comorbidity burden compared to Tier B hospitals (all P Conclusions Low-risk patients can safely undergo SAVR in both Tier levels without compromising outcomes. Establishment of quality of care measures, especially in the SAVR-only hospitals, remains paramount and should be closely integrated when designing Tier-based systems for AVR care.