PDF(Pubmed)
Abstract：
UNASSIGNED: Procedure volumes are associated with outcomes for many cardiovascular procedures, leading to guidelines on minimum volume thresholds for certain procedures; however, the volume-outcome relationship with left atrial appendage occlusion is poorly understood. As such, we sought to determine the relationship between hospital and physician volume and WATCHMAN left atrial appendage occlusion procedural success overall and with the new generation WATCHMAN FLX device.
UNASSIGNED: We performed an analysis of WATCHMAN procedures (January 2019 to October 2021) from the National Cardiovascular Data Registry LAAO Registry. Three-level hierarchical generalized linear models were used to assess the adjusted relationship between procedure volume and procedural success (device released with peridevice leak <5 mm, no in-hospital major adverse events).
UNASSIGNED: Among 87 480 patients (76.2±8.0 years; 58.8% men; mean CHA2DS2-VASc score, 4.8±1.5) from 693 hospitals, the procedural success rate was 94.2%. With hospital volume Q4 (greatest volume) as the reference, the likelihood of procedural success was significantly less among Q1 (odds ratio [OR], 0.66 [CI, 0.57-0.77]) and Q2 (OR, 0.78 [CI, 0.69-0.90]) but not Q3 (OR, 0.95 [CI, 0.84-1.07]). With physician volume Q4 (greatest volume) as the reference, the likelihood of procedural success was significantly less among Q1 (OR, 0.72 [CI, 0.63-0.82]), Q2 (OR, 0.79 [CI, 0.71-0.89]), and Q3 (OR, 0.88 [CI, 0.79-0.97]). Among WATCHMAN FLX procedures, there was attenuation of the volume-outcome relationships, with statistically significant but modest absolute differences of only ≈1% across volume quartiles.
UNASSIGNED: In this contemporary national analysis, greater hospital and physician WATCHMAN volumes were associated with increased procedure success. The WATCHMAN FLX transition was associated with increased procedural success and less heterogeneity in outcomes across volume quartiles. These findings indicate the importance of understanding the volume-outcome relationship for individual left atrial appendage occlusion devices.
UNASSIGNED: We performed an analysis of WATCHMAN procedures (January 2019 to October 2021) from the National Cardiovascular Data Registry LAAO Registry. Three-level hierarchical generalized linear models were used to assess the adjusted relationship between procedure volume and procedural success (device released with peridevice leak <5 mm, no in-hospital major adverse events).
UNASSIGNED: Among 87 480 patients (76.2±8.0 years; 58.8% men; mean CHA2DS2-VASc score, 4.8±1.5) from 693 hospitals, the procedural success rate was 94.2%. With hospital volume Q4 (greatest volume) as the reference, the likelihood of procedural success was significantly less among Q1 (odds ratio [OR], 0.66 [CI, 0.57-0.77]) and Q2 (OR, 0.78 [CI, 0.69-0.90]) but not Q3 (OR, 0.95 [CI, 0.84-1.07]). With physician volume Q4 (greatest volume) as the reference, the likelihood of procedural success was significantly less among Q1 (OR, 0.72 [CI, 0.63-0.82]), Q2 (OR, 0.79 [CI, 0.71-0.89]), and Q3 (OR, 0.88 [CI, 0.79-0.97]). Among WATCHMAN FLX procedures, there was attenuation of the volume-outcome relationships, with statistically significant but modest absolute differences of only ≈1% across volume quartiles.
UNASSIGNED: In this contemporary national analysis, greater hospital and physician WATCHMAN volumes were associated with increased procedure success. The WATCHMAN FLX transition was associated with increased procedural success and less heterogeneity in outcomes across volume quartiles. These findings indicate the importance of understanding the volume-outcome relationship for individual left atrial appendage occlusion devices.
摘要：
■手术量与许多心血管手术的结果相关，导致关于某些程序的最小体积阈值的准则；然而，对左心耳封堵术的容积与结局的关系知之甚少.因此，我们试图确定医院和医师容量与WATCHMAN左心耳封堵手术总体成功率和新一代WATCHMANFLX装置之间的关系.
■我们从国家心血管数据登记处LAAO登记处对WATCHMAN程序（2019年1月至2021年10月）进行了分析。三级分层广义线性模型用于评估手术体积与手术成功之间的调整关系（设备周围泄漏<5mm时释放的设备，无院内重大不良事件)。
■在87480例患者中（76.2±8.0岁；58.8％的男性；平均CHA2DS2-VASc评分，4.8±1.5)来自693家医院，手术成功率为94.2%.以医院体积Q4(最大体积)为参考，在第一季度中，程序成功的可能性明显较小(赔率比[OR]，0.66[CI，0.57-0.77])和Q2(OR，0.78[CI，0.69-0.90])，但不是Q3(OR，0.95[CI，0.84-1.07]）。以医生体积Q4（最大体积）为参考，在第一季度中，程序成功的可能性明显较小(OR，0.72[CI，0.63-0.82])，Q2(或,0.79[CI，0.71-0.89])，和Q3（或，0.88[CI，0.79-0.97]）。在WATCHMANFLX程序中，体积-结果关系减弱，在体积四分位数之间具有统计学上的显着但适度的绝对差异，仅≈1％。
■在这种当代国家分析中，医院和医师WATCHMAN容量增加与手术成功率增加相关.WATCHMANFLX转换与增加的手术成功率和减少的跨体积四分位数的结果异质性相关。这些发现表明了解单个左心耳封堵装置的体积-结果关系的重要性。
■我们从国家心血管数据登记处LAAO登记处对WATCHMAN程序（2019年1月至2021年10月）进行了分析。三级分层广义线性模型用于评估手术体积与手术成功之间的调整关系（设备周围泄漏<5mm时释放的设备，无院内重大不良事件)。
■在87480例患者中（76.2±8.0岁；58.8％的男性；平均CHA2DS2-VASc评分，4.8±1.5)来自693家医院，手术成功率为94.2%.以医院体积Q4(最大体积)为参考，在第一季度中，程序成功的可能性明显较小(赔率比[OR]，0.66[CI，0.57-0.77])和Q2(OR，0.78[CI，0.69-0.90])，但不是Q3(OR，0.95[CI，0.84-1.07]）。以医生体积Q4（最大体积）为参考，在第一季度中，程序成功的可能性明显较小(OR，0.72[CI，0.63-0.82])，Q2(或,0.79[CI，0.71-0.89])，和Q3（或，0.88[CI，0.79-0.97]）。在WATCHMANFLX程序中，体积-结果关系减弱，在体积四分位数之间具有统计学上的显着但适度的绝对差异，仅≈1％。
■在这种当代国家分析中，医院和医师WATCHMAN容量增加与手术成功率增加相关.WATCHMANFLX转换与增加的手术成功率和减少的跨体积四分位数的结果异质性相关。这些发现表明了解单个左心耳封堵装置的体积-结果关系的重要性。
