Higher Hospital Volume Linked to Better TAVR Outcomes

Lowndes K, Zacharias G, Moynihan C, Alcudia AA, et al. Institutional Volume and County-Level Socioeconomic Characteristics in Transcatheter Aortic Valve Replacement Outcomes. J Am Coll Surg. September 2026

Higher institutional transcatheter aortic valve replacement (TAVR) volume was associated with better short-term outcomes, particularly lower stroke rates, while associations with county socioeconomic characteristics were less consistent.

Lowndes et al. analyzed 336 hospital-measure observations from 85 California hospitals performing TAVR in 2022–2023. Using CMS data, they linked hospital risk-adjusted 30-day mortality and stroke rates with county household income, insurance coverage, and racial composition. Models accounted for procedural volume, year, and differences among hospitals.

Greater TAVR volume was associated with lower mortality (p = 0.046) and stroke rates (p = 0.001). The stroke association persisted in sensitivity analysis, whereas the mortality association was no longer statistically significant.

County income and racial composition were not associated with mortality. Lower-income counties had lower unadjusted stroke rates, but that association disappeared after full adjustment. Researchers also found no significant interaction between income and hospital volume.

The findings identify hospital procedure volume as the most consistent correlate of favorable outcomes, especially stroke. However, county-level findings cannot rule out disparities among individual patients. The authors called for further investigation of care-delivery characteristics at experienced TAVR centers that may contribute to better outcomes.