• 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 TAVR utilization ratio (number of TAVR/total AVR volume) on TAVR, 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 based on their TAVR/AVR ratio. Centers with a ratio below the 1st quartile were considered "low ratio", centers in the 2nd and the 3rd quartile "balanced ratio", and centers above the 3rd 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 to centers with low ratio (1.9% vs 2.1%, p=0.01) and lower complication rate compared to centers with high ratio (34.8% vs 36.8%, p<0.001). Centers with a balanced ratio had lower TAVR complication rate compared to centers with low ratio (37.3% vs 39%, p<0.001). For SAVR outcome, centers with an balanced ratio had lower post-SAVR mortality (2.1% vs 2.6%, p<0.001) and complication rate (28.6% vs 30.3%, p<0.001) than centers with high ratio.ConclusionCenters with balanced TAVR ratios had superior outcomes compared to centers with low or high ratios. These data support the use of a balanced Heart Team to optimize AVR outcomes.Copyright © 2024. Published by Elsevier Inc.

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