Volume-Outcome Relationship in Surgical and Cardiac Transcatheter Interventions with a Focus on Transcatheter Aortic Valve Implantation

Practice makes perfect is an old saying that can be true for complex interventions. There is a strong and persistent relationship between high volume and better outcomes with more than 300 studies being reported on the subject. The more complex the procedure, the greater the volume-outcome relationship is. Failure to rescue was shown to be one of the factors explaining higher mortality rates post complex surgery. High-volume centers provide a better safety net, thanks to the structure and better protocols, and low-volume operators have better results at high-volume centers than at low-volume centers. Finally, effort should be made to regroup complex procedures in high-volume centers, but without compromising patient access to the procedures. Adaptation to local and geographic constraints is important.

Automated summary

Practice is important in complex interventions, as there is a strong relationship between high volume and better outcomes. The complexity of the procedure affects the volume-outcome relationship. Failure to rescue is a factor leading to higher mortality rates after complex surgery. High-volume centers offer a better safety net with improved structure and protocols, while low-volume operators have better results in high-volume centers.