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Invited Commentary
November 2018

10 000 Hours—Is Prior Experience in Cardiac Surgery Enough?

Author Affiliations
  • 1Department of Cardiology, Houston Methodist Hospital, Houston, Texas
  • 2Cardiothoracic Surgery, Cardiovascular Research, Houston Methodist Hospital, Houston, Texas
JAMA Cardiol. 2018;3(11):1078-1080. doi:10.1001/jamacardio.2018.3657

In this issue of JAMA Cardiology, Mao et al1 have written about the association between hospital surgical aortic valve replacement (SAVR) volume, transcatheter aortic valve replacement (TAVR), and patient outcomes.1 The authors look at the association in 438 hospitals between October 2011 and December 2015 among Medicare beneficiaries. The primary outcome of the study was patient mortality within 30 days following their TAVR procedure. Secondary outcomes were patient 30-day mortality or stroke, 30-day hospital readmission, and 1-year and 2-year mortality. Data were collected using Medicare Provider and Analysis Review and Master Beneficiary Summary Files information. The purpose of the study appears to be testing the validity of the national coverage decision requirement for a baseline number of SAVR cases for payment. Recognizing the potential interdependence of SAVR and TAVR volumes, the authors created 4 groups for testing: low SAVR/low TAVR, high SAVR/low TAVR, low SAVR/high TAVR, and high SAVR/high TAVR. High-SAVR centers did at least 97 SAVRs per year and high-TAVR centers did more than the median for TAVR most of the time. They found that high-SAVR–volume hospitals were more likely to be early TAVR adopters and have faster TAVR growth. High SAVR volume alone was not associated with mortality but high SAVR volume combined with high TAVR volume was. However, high TAVR volume alone was associated with better short-term and midterm outcomes regardless of SAVR volume, with high-SAVR centers tending to have large TAVR programs.