Increased Mortality at Low-Volume Orthotopic Heart Transplantation Centers: Should Current Standards Change? Eric S. Weiss, MD, Robert A. Meguid, MD,

Slides:

Advertisements

Similar presentations

Survival After Single Versus Bilateral Lung Transplantation for High-Risk Patients With Pulmonary Fibrosis Eric S. Weiss, MD, MPH, Jeremiah G. Allen,

Advertisements

Operative outcomes in mitral valve surgery: Combined effect of surgeon and hospital volume in a population-based analysis Arman Kilic, MD, Ashish S.

Results of Coronary Artery Endarterectomy and Coronary Artery Bypass Grafting for Diffuse Coronary Artery Disease Srikrishna Sirivella, MD, Isaac Gielchinsky,

Is Hospital Procedure Volume a Reliable Marker of Quality for Coronary Artery Bypass Surgery? A Comparison of Risk and Propensity Adjusted Operative and.

What Predicts Long-Term Survival After Heart Transplantation

Darrell Wu, MD, Matt D. Price, MS, Hiruni S. Amarasekara, MS, Susan Y

Treating Constrictive Pericarditis in a Chinese Single-Center Study: A Five-Year Experience Yiyun Lin, MD, Mi Zhou, MMS, Jian Xiao, MD, Bin Wang, MD,

Niv Ad, MD, Linda Henry, PhD, RN, Deborah J. Shuman, BS, Sari D

Phillips B. Harrington, MD, William W. McAlexander, MD, Ayesha S

Lisa M. Brown, MD, MAS, David T. Cooke, MD, Elizabeth A. David, MD

Heart Transplantation for the Failing Fontan

Michael E. Halkos, MD, Patrick Kilgo, MS, Omar M

ABO-Identical Blood Group Matching Has No Survival Benefit for AB Heart Transplant Recipients Henrik Bergenfeldt, MD, Peter Höglund, MD, PhD, Bodil Andersson,

Comparing Long-Term Survival Between Patients Undergoing Off-Pump and On-Pump Coronary Artery Bypass Graft Operations Giovanni Filardo, PhD, MPH, Paul.

Robert E. Merritt, MD, Richard I. Whyte, MD, Nicole T

The Impact of Peripheral Vascular Disease on Long-Term Survival After Coronary Artery Bypass Graft Surgery Danny Chu, MD, Faisal G. Bakaeen, MD, Xing.

Influence of Pulmonary Hypertension on Patients With Idiopathic Pulmonary Fibrosis Awaiting Lung Transplantation Don Hayes, MD, MS, Sylvester M. Black,

The Optimal Timing of Stage-2-Palliation After the Norwood Operation

Lymph Node Evaluation Achieved by Open Lobectomy Compared With Thoracoscopic Lobectomy for N0 Lung Cancer Robert E. Merritt, MD, Chuong D. Hoang, MD,

Michael Eberlein, MD, PhD, Robert M

Surgical Ventricular Restoration for Advanced Congestive Heart Failure: Should Pulmonary Hypertension Be a Contraindication? Nishant D. Patel, BA, Jason.

The Survival Benefit of Simultaneous Heart-Kidney Transplantation Extends Beyond Dialysis-Dependent Patients Arman Kilic, MD, Joshua C. Grimm, MD, Glenn.

Surgery in Adults With Congenital Heart Disease: Risk Factors for Morbidity and Mortality Brian Kogon, MD, Joanna Grudziak, MA, Anurag Sahu, MD, Maan.

Pulmonary Resection in the Treatment of Multidrug-Resistant Tuberculosis: A Retrospective Study of 56 Cases Haifeng Wang, MM, Hongsheng Lin, MM, Gening.

Increased Aorto-Mitral Curtain Thickness Independently Predicts Mortality in Patients With Radiation-Associated Cardiac Disease Undergoing Cardiac Surgery

Darrell Wu, MD, Matt D. Price, MS, Hiruni S. Amarasekara, MS, Susan Y

Reversible Pulmonary Hypertension in Heart Transplant Candidates: To Transplant or Not to Transplant Stefan Klotz, MD, Frauke Wenzelburger, MD, Joerg.

Outcomes in Patients Bridged With Univentricular and Biventricular Devices in the Modern Era of Heart Transplantation Joshua C. Grimm, MD, Christopher.

Established Preoperative Risk Factors Do Not Predict Long-Term Survival in Isolated Coronary Artery Bypass Grafting Patients Giovanni Filardo, PhD, MPH,

Total Arterial Revascularization: A Superior Strategy for Diabetic Patients Who Require Coronary Surgery James Tatoulis, MD, FRACS, Rochelle Wynne, PhD,

Asad A. Shah, MD, Mathias Worni, MD, MHS, Christopher R

Origins of the Cardiothoracic Surgery Network (CTSNet)

Prior Sternotomy and Ventricular Assist Device Implantation Do Not Adversely Impact Survival or Allograft Function After Heart Transplantation Ann C.

Todd C. Crawford, MD, J. Trent Magruder, MD, Joshua C

Todd C. Crawford, MD, J. Trent Magruder, MD, Joshua C

Saving Lives Is More Important Than Abstract Moral Concerns: Financial Incentives Should Be Used to Increase Organ Donation Benjamin Hippen, MD, Lainie.

Ross Versus Non-Ross Aortic Valve Replacement in Children: A 22-Year Single Institution Comparison of Outcomes John W. Brown, MD, Parth M. Patel, BS,

Elliot Wakeam, MD, MPH, James P. Byrne, MD, Gail E

Comparison of the 6th and 7th Editions of the American Joint Committee on Cancer Tumor-Node-Metastasis Staging System in Patients With Resected Esophageal.

Jaimin R. Trivedi, MD, MPH, Allen Cheng, MD, Michele Gallo, MD, Erin M

Should Patients 60 Years and Older Undergo Bridge to Transplantation With Continuous-Flow Left Ventricular Assist Devices? Jeremiah G. Allen, MD, Arman.

Pankaj Saxena, FRACS, PhD, Lyle D. Joyce, MD, PhD, Richard C

Felix G. Fernandez, MD, Onkar Khullar, MD, Seth D

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

The Simplified Acute Physiology Score II as a Predictor of Mortality in Patients Who Underwent Extracorporeal Membrane Oxygenation for Septic Shock Myung.

Interaction of Donor and Recipient Age: Do Older Heart Transplant Recipients Require Younger Hearts? Malini Daniel, MD, Carol Chen, MD, Jennifer Chung,

Acute Kidney Injury Increases Mortality After Lung Transplantation

Eric S. Weiss, MD, MPH, Jeremiah G. Allen, MD, Christian A

Arman Kilic, MD, Eric S. Weiss, MD, MPH, Jeremiah G

Right Heart Dysfunction After Left Ventricular Assist Device Implantation: A Comparison of the Pulsatile HeartMate I and Axial-Flow HeartMate II Devices

Kevin L. Greason, MD, Brian D. Lahr, MS, John M

William M. Whited, MD, Paul Henley, BS, Erin M

Mitral Valve Repair for Degenerative Disease: A 20-Year Experience

Optimal Timing for Elective Early Primary Repair of Tetralogy of Fallot: Analysis of Intermediate Term Outcomes Michael E.A. Cunningham, MD, Mary T.

Pretransplant Panel Reactive Antibodies in Human Lung Transplantation: An Analysis of Over 10,000 Patients Ashish S. Shah, MD, Lois Nwakanma, MD, Christopher.

Is Early Too Early? Effect of Shorter Stays After Bypass Surgery

Single Versus Double Lung Retransplantation Does Not Affect Survival Based on Previous Transplant Type Erin M. Schumer, MD, MPH, Jonathan D. Rice, MD,

Survival After Isolated Coronary Artery Bypass Grafting in Patients With Severe Left Ventricular Dysfunction Waleed A. Ahmed, MD, Phillip J. Tully, BHSc(Hons),

Bleeding Complications and Blood Product Utilization With Left Ventricular Assist Device Implantation Justin M. Schaffer, MS, George J. Arnaoutakis,

Trends in Patient Characteristics and Outcomes of Coronary Artery Bypass Grafting in the 2000 to 2012 Medicare Population Christian McNeely, MD, Stephen.

Interinstitutional Comparison of Risk-Adjusted Mortality and Length of Stay in Congenital Heart Surgery William M. DeCampli, MD, PhD, Redmond P. Burke,

Completeness of Revascularization and Survival Among Octogenarians With Triple- Vessel Disease Siamak Mohammadi, MD, Dimitri Kalavrouziotis, MD, Francois.

Hybrid Debranching With Endovascular Repair for Thoracoabdominal Aneurysms: A Comparison With Open Repair Himanshu J. Patel, MD, Gilbert R. Upchurch,

Preoperative Performance Status Impacts Perioperative Morbidity and Mortality After Lung Transplantation Joshua C. Grimm, MD, Vicente Valero, MD, Arman.

The Impact of Volume Reduction on Early and Long-Term Outcomes in Surgical Ventricular Restoration for Severe Heart Failure Nathan Wm. Skelley, BS, Jeremiah.

The American Board of Thoracic Surgery: Update

Creation of a Quantitative Score to Predict the Need for Mechanical Support in Children Awaiting Heart Transplant Ryan R. Davies, MD, Shylah Haldeman,

Sara K. Pasquali, MD, MHS, Xia He, MS, Marshall L

Self-Management of Oral Anticoagulation Therapy Improves Long-Term Survival in Patients With Mechanical Heart Valve Replacement Heinrich Koertke, MD,

Marginal Donor Use in Patients Undergoing Heart Transplantation With Left Ventricular Assist Device Explantation Marat Fudim, MD, Mary E. Davis, MS,

Presentation transcript:

Increased Mortality at Low-Volume Orthotopic Heart Transplantation Centers: Should Current Standards Change? Eric S. Weiss, MD, Robert A. Meguid, MD, MPH, Nishant D. Patel, BA, Stuart D. Russell, MD, Ashish S. Shah, MD, William A. Baumgartner, MD, John V. Conte, MD The Annals of Thoracic Surgery Volume 86, Issue 4, Pages 1250-1260 (October 2008) DOI: 10.1016/j.athoracsur.2008.06.071 Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Distribution of center volumes for 143 centers included in the United Network for Organ Sharing dataset. Sixty-four centers fall below the requirement for Centers for Medicare and Medicaid Services funding of 10 orthotopic heart transplantations per year (based on Organ Procurement and Transplantation Network data, January 2007). The Annals of Thoracic Surgery 2008 86, 1250-1260DOI: (10.1016/j.athoracsur.2008.06.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Individual center unadjusted percent mortality as plotted by mean annual center orthotopic heart transplantation volume. Both (A) 30-day and (B) 1-year mortality censored for 30-day mortality are included. Data trend lines are provided, demonstrating the substantial effect that center volume has on 30-day mortality (based on Organ Procurement and Transplantation Network data, January 2007). The Annals of Thoracic Surgery 2008 86, 1250-1260DOI: (10.1016/j.athoracsur.2008.06.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Kaplan-Meier estimates of 5-year survival for patients who underwent orthotopic heart transplantation (OHT) at high-volume (black line) and low-volume (gray dashed line) centers. A survival table is provided, and the number of patients at risk is given in parentheses. The p value corresponds to Mantel-Cox log-rank test results (based on Organ Procurement and Transplantation Network data, January 2007). The Annals of Thoracic Surgery 2008 86, 1250-1260DOI: (10.1016/j.athoracsur.2008.06.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Kaplan-Meier estimates of 5-year survival censored for patients who died before 1-year follow-up and stratified by mean center volume. A total of 10,347 patients survived beyond 1 year. The only group that varied significantly from others was those centers performing 5 or fewer OHTs per year. *p < 0.001 for this volume group when compared with the others using the Mantel-Cox log-rank test (based on Organ Procurement and Transplantation Network data, January 2007). The Annals of Thoracic Surgery 2008 86, 1250-1260DOI: (10.1016/j.athoracsur.2008.06.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Various models of goodness of fit: area under the receiver operating curve (AUC [black]) and McFadden's pseudo R2 as a percentage (gray) of the sequential multiple logistic regression analyses performed at sequential volume cutoffs. Black and gray arrows point to goodness of fit for comparison between centers performing 10 or more cases per year versus fewer than 10 cases per year. This plot demonstrates that the current Centers for Medicare and Medicaid Services standard of 10 OHTs per year was not the optimal fit in this model. The dotted line represents the baseline AUC for the model with no volume variable, which was 0.6415. The Annals of Thoracic Surgery 2008 86, 1250-1260DOI: (10.1016/j.athoracsur.2008.06.071) Copyright © 2008 The Society of Thoracic Surgeons Terms and Conditions