• Theodore Marghitu, Sophia H Roberts, June He, Nicholas Kouchoukos, Puja Kachroo, Harold Roberts, Ralph Damiano, Alan Zajarias, Marc Sintek, John Lasala, Alexander A Brescia, and Tsuyoshi Kaneko.
• Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St Louis School of Medicine, St Louis, Mo.
• J. Thorac. Cardiovasc. Surg. 2024 Nov 7.

ObjectiveUse of the Heart Team has been the standard of care for the treatment of aortic valve disease; however, its efficacy has not been evaluated. We sought to analyze its impact using the transcatheter aortic valve replacement (TAVR) use ratio (number of TAVR/total aortic valve replacement [AVR] volume) on TAVR, surgical aortic valve replacement (SAVR), and overall AVR outcomes.MethodsWe analyzed all TAVRs and SAVRs sampled by the National Readmissions Database between 2016 and 2020. Hospitals were stratified into quartiles on the basis of their TAVR/AVR ratio. Centers with a ratio below the first quartile were considered "low ratio," centers in the second and the third quartile "balanced ratio," and centers above the third quartile "high ratio." Primary outcomes were 30-day mortality and complication rate, which included stroke, renal failure, heart block, pacemaker placement, and valve regurgitation.ResultsFor overall AVR outcomes, centers with a balanced ratio had lower mortality compared with centers with low ratio (1.9% vs 2.1%, P = .01) and lower complication rate compared with centers with high ratio (34.8% vs 36.8%, P < .001). Centers with a balanced ratio had lower TAVR complication rate compared with centers with low ratio (37.3% vs 39%, P < .001). For SAVR outcome, centers with an balanced ratio had lower post-SAVR mortality (2.1% vs 2.6%, P < .001) and complication rate (28.6% vs 30.3%, P < .001) than centers with high ratio.ConclusionsCenters with balanced TAVR ratios had superior outcomes compared with centers with low or high ratios. These data support the use of a balanced Heart Team to optimize AVR outcomes.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.

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