Minireviews
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Apr 26, 2016; 8(4): 302-309
Published online Apr 26, 2016. doi: 10.4330/wjc.v8.i4.302
Influence of hospital volume and outcomes of adult structural heart procedures
Sidakpal S Panaich, Nilay Patel, Shilpkumar Arora, Nileshkumar J Patel, Samir V Patel, Chirag Savani, Vikas Singh, Rajesh Sonani, Abhishek Deshmukh, Michael Cleman, Abeel Mangi, John K Forrest, Apurva O Badheka
Sidakpal S Panaich, Interventional Cardiology, Borgess Medical Center, Kalamazoo, MI 49048, United States
Nilay Patel, Internal Medicine, Saint Peter’s University Hospital, New Brunswick, NJ 08901, United States
Shilpkumar Arora, Internal Medicine, Mount Sinai St. Luke’s Roosevelt Hospital, New York City, NY 10025, United States
Nileshkumar J Patel, Vikas Singh, Department of Cardiology, University of Miami Miller School of Medicine, Miami, FL 33136, United States
Samir V Patel, Internal Medicine, Western Reserve Health Education, Youngstown, OH 445054, United States
Chirag Savani, Internal Medicine, New York Medical College, Valhalla, NY 10595, United States
Rajesh Sonani, Public Health Department, Emory University School of Medicine, Atlanta, GA 30307, United States
Abhishek Deshmukh, Department of Cardiology, Mayo Clinic, Rochester, MN 55905, United States
Michael Cleman, Abeel Mangi, John K Forrest, Department of Cardiology, Yale School of Medicine, New Haven, CT 06510, United States
Apurva O Badheka, Department of Cardiology, the Everett Clinic, Everett, WA 98201, United States
Author contributions: Panaich SS, Patel N and Badheka AO contributed equally in this study; Panaich SS and Singh V were responsible for study design, concept and text of the manuscript; Arora S, Patel NJ and Savani C analyzed the data; Patel SV, Deshmukh A, Sonani R, Cleman M, Mangi A and Forrest JK did critical revision for important intellectual content.
Conflict-of-interest statement: None of the authors have any conflict of interest regarding the content of this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Apurva O Badheka, MD, FACP, CCDS, RPVI, Department of Cardiology, the Everett Clinic, 3901 Hoyt Ave, Everett, WA 98201, United States. abadheka@everettclinic.com
Telephone: +1-408-3244516
Received: June 24, 2015
Peer-review started: June 24, 2015
First decision: August 25, 2015
Revised: September 23, 2015
Accepted: January 21, 2016
Article in press: January 22, 2016
Published online: April 26, 2016
Processing time: 299 Days and 10.6 Hours
Abstract

Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. Seminal work on hospital volume relationships was done by Luft et al more than 4 decades ago, when they demonstrated that hospitals performing > 200 surgical procedures a year had 25%-41% lower mortality than those performing fewer procedures. Numerous volume-outcome studies have since been done for varied surgical procedures. An old adage “practice makes perfect” indicating superior operator and institutional experience at higher volume hospitals is believed to primarily contribute to the volume outcome relationship. Compelling evidence from a slew of recent publications has also highlighted the role of hospital volume in predicting superior post-procedural outcomes following structural heart disease interventions. These included transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure. This is especially important since these structural heart interventions are relatively complex with evolving technology and a steep learning curve. The benefit was demonstrated both in lower mortality and complications as well as better economics in terms of lower length of stay and hospitalization costs seen at high volume centers. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions.

Keywords: Hospital volume; Transcatheter mitral valve repair; Septal ablation; Septal myectomy; Transcatheter aortic valve repair; Left atrial appendage closure

Core tip: Hospital volume is regarded amongst many in the medical community as an important quality metric. This is especially true in more complicated and less commonly performed procedures such as structural heart disease interventions. We present an overview of the available literature that underscores the importance of hospital volume in complex structural heart disease interventions including transcatheter aortic valve repair, transcatheter mitral valve repair, septal ablation and septal myectomy for hypertrophic obstructive cardiomyopathy, left atrial appendage closure and atrial septal defect/patent foramen ovale closure.