CCSIP 2015 update: TAVR taking a bite out of SAVR?

The CCSIP reporting website was updated through 2014, now including a breakdown of aortic valve replacement procedures between transcatheter AVR (TAVR) and surgical AVR (SAVR).  At several sites where significant volumes of TAVR are being performed, SAVR volumes have decreased.  For example, at Cedars Sinai Medical Center, SAVR has decreased by 50%:

Statewide, TAVR represented 30% of all isolated AVRs during 2013-2014.  However, overall, isolated SAVR volume has not yet been affected; 7074 AVRs were performed in 2011-2012 and 7022 in 2013-2014.  Further details about CABG, PCI and Heart valve volumes and outcomes are available at the CCSIP reporting website.

Heart Valve Outcomes also Improve

The California CABG Outcomes Reporting Program (CCORP) has collected data on all isolated CABG and CABG-valve procedures since 2003.  Only isolated CABG outcomes are reported.  CABG mortality rates subsequently decreased significantly.  In a recent CASTS study, in-hospital mortality rates for heart valve procedures were also found to decrease markedly after the introduction of public reporting of CABG.  This finding did not appear to be related to risk avoidance or mortality deferral based on increased procedure numbers, increased predicted risk and unchanged late mortality and adverse event rates. See Heart Valve Outcomes 1999-2011 abstract.


Adverse Events Decrease

In a recent CASTS study, adverse events after coronary revascularization procedures decreased markedly in California in the first decade of the 21st century. The report, published in the American Journal of Cardiology on August 15, found that the volume of coronary interventions (PCI and CABG) in California decreased, and adverse event rates (death, stroke, acute MI or reintervention) also decreased after the introduction of public reporting and drug-eluting stents in 2003. Lower procedure volume combined with improved outcomes resulted in an annual decrease of >6,000 adverse events by the end of the decade.  See CASTS AJC 08152013