High-risk patients transplanted at low-volume centers had a 67% increased risk of death after one year compared with high-risk patients transplanted at high-volume centers. Severity of condition alone did not account for the difference, which diminished among low-risk patients, the research showed.
"Patients at high risk of mortality should probably only be transplanted at high-volume centers," Arnaoutakis said.
Arnaoutakis said the findings aren't an indictment of the training and skill of surgeons at low-volume centers, but more likely reflect the systems and infrastructure of a center doing few heart transplants.
"There are certain processes that may be better performed at regional centers of excellence doing more of a certain procedure," he said. "People talk about it with airline pilots -- only at 10,000 hours of flying are they considered expert at flying. The experience of a center can be discussed in similar terms."
Nurses at a high-volume center, for example, may be quicker to recognize complications and intervene earlier, he said. Operating room teams might be better prepared to handle a transplant that occurs in the middle of the night.
"The more you do it, the better you become at doing it," he said.