{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T21:37:52Z","timestamp":1769809072437,"version":"3.49.0"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>Current national performance metrics rank transcatheter aortic valve replacement (TAVR) centers based on risk-adjusted outcomes. This could make operators\/centers less inclined to offer TAVR in high-risk cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We used simulation models based on registry data to explore whether avoiding high-risk TAVR cases would improve the hospitals\u2019 comparative risk-adjusted TAVR outcomes. This multicenter, retrospective cohort study included all adults (\u226518 years) who underwent TAVR in the Society of Thoracic Surgeons\/American College of Cardiology Transcatheter Valve Therapy registry in 2021. We evaluated hospital-level, risk-adjusted outcomes, before and after simulating the omission of the top 10% highest-risk patients. The primary outcome was a 30-day composite of death, stroke, VARC major\/life-threatening\/disabling bleeding, renal failure, or moderate\/severe para-valvular leak. The secondary outcome was 30-day death. We used the mean difference\u00b1SD in the win ratio and observed\/expected ratio for evaluation of the primary and secondary outcomes, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      There were 43\u2009907 TAVR cases with available primary outcome data and 56\u2009982 cases with available secondary outcome data. Median age was 79 (73\u201384) years, 57% were men, and 93% were White race. Our simulation demonstrates that, on average, excluding the top 10% highest-risk patients from centers\u2019 case mix would not change their hospital-level, risk-adjusted win ratio (mean difference, 0.002\u00b10.067;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.60) or observed\/expected ratio (mean difference, -0.003\u00b10.633;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.90).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Hospital-level, risk-adjusted TAVR outcomes did not consistently improve with simulated strategies of avoiding the highest-risk cases. Operators and centers can be reassured that they can continue to offer TAVR to high-risk patients, as clinically indicated, without the sole focus on being penalized via quality measures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.125.015273","type":"journal-article","created":{"date-parts":[[2025,12,4]],"date-time":"2025-12-04T10:00:59Z","timestamp":1764842459000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Will a Conservative Case Selection Strategy Improve Hospital-Level TAVR Performance Metrics?"],"prefix":"10.1161","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3327-1718","authenticated-orcid":true,"given":"Ahmed A.","family":"Kolkailah","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI (A.A.K.)."},{"name":"Brown University Health Cardiovascular Institute, Providence, RI (A.A.K.)."},{"name":"Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (A.A.K., A.M.N., E.D.P., D.J.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6197-9860","authenticated-orcid":true,"given":"Ann Marie","family":"Navar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (A.A.K., A.M.N., E.D.P., D.J.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1599-2957","authenticated-orcid":true,"given":"Sreekanth","family":"Vemulapalli","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Duke University Medical Center, Durham, NC (S.V.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pratik","family":"Manandhar","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (P.M., J.L.B., A.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph Leo","family":"Brothers","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (P.M., J.L.B., A.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4151-5185","authenticated-orcid":true,"given":"Andrzej","family":"Kosinski","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Durham, NC (P.M., J.L.B., A.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5415-4721","authenticated-orcid":true,"given":"Eric D.","family":"Peterson","sequence":"additional","affiliation":[{"name":"Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (A.A.K., A.M.N., E.D.P., D.J.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4321-4538","authenticated-orcid":true,"given":"Dharam J.","family":"Kumbhani","sequence":"additional","affiliation":[{"name":"Division of Cardiology, UT Southwestern Medical Center, Dallas, TX (A.A.K., A.M.N., E.D.P., D.J.K.)."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000001106"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD013319.pub2"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2023.07.026"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.09.048"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2019.4657"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.120.051456"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.121.054897"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.09.595"},{"key":"e_1_3_3_10_2","unstructured":"STS\/ACC TVT public reporting. 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