Institutional volume and the effect of recipient risk on short-term mortality after orthotopic heart transplant George J. Arnaoutakis, MD, Timothy J.

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Institutional volume and the effect of recipient risk on short-term mortality after orthotopic heart transplant George J. Arnaoutakis, MD, Timothy J. George, MD, Jeremiah G. Allen, MD, Stuart D. Russell, MD, Ashish S. Shah, MD, John V. Conte, MD, Eric S. Weiss, MD, MPH The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 1, Pages 157-167.e1 (January 2012) DOI: 10.1016/j.jtcvs.2011.09.040 Copyright © 2012 Terms and Conditions

Figure 1 A, Bar graph depicting actual 30-day mortality by center volume (low, medium, and high) according to increasing risk strata. P values are nonsignificant except where explicitly noted on the plot region. B, Bar graph depicting actual 1-year mortality by center volume (low, medium, and high) according to increasing risk strata. P values are nonsignificant except where explicitly noted on the plot region. OHT, Orthotopic heart transplant. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 157-167.e1DOI: (10.1016/j.jtcvs.2011.09.040) Copyright © 2012 Terms and Conditions

Figure 2 Best-fit Lowess smoothed line for observed 1-year mortality by level of center volume (low, medium, and high) plotted against predicted 1-year mortality according to Index for Mortality Prediction After Cardiac Transplantation (IMPACT) score. The 95% confidence interval (CI) for predicted mortality is in the shaded area. OHT, Orthotopic heart transplant. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 157-167.e1DOI: (10.1016/j.jtcvs.2011.09.040) Copyright © 2012 Terms and Conditions

Figure 3 Scatter plot of center-level 1-year mortality according to 3 tiers of center volume. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 157-167.e1DOI: (10.1016/j.jtcvs.2011.09.040) Copyright © 2012 Terms and Conditions

Figure 4 Relative risk of 1-year mortality plotted against center volume as a continuous variable on the abscissa. Stratification was performed according to 4 quartiles of recipient risk according to the Index for Mortality Prediction After Cardiac Transplantation (IMPACT) risk index. Relative risk crosses 1 for the lower 2 quartiles at an annual center volume of approximately 10 orthotopic heart transplant (OHT) procedures/y, whereas for the 2 higher quartiles of recipient risk, the risk of 1-year mortality crosses 1 at an annual center volume of approximately 35 to 40 orthotopic heart transplant procedures/y. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 157-167.e1DOI: (10.1016/j.jtcvs.2011.09.040) Copyright © 2012 Terms and Conditions

Figure 5 A, Kaplan-Meier cumulative 1-year survival of recipients in the cohort overall, stratified by center volume. B, Kaplan-Meier cumulative 1-year survival of high-risk recipients (risk score >10), stratified by center volume. OHT, Orthotopic heart transplant. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 157-167.e1DOI: (10.1016/j.jtcvs.2011.09.040) Copyright © 2012 Terms and Conditions