The Effect of Institutional Volume on Complications and Their Impact on Mortality After Pediatric Heart Transplantation Cecillia Lui, MD, Joshua C. Grimm,

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The Effect of Institutional Volume on Complications and Their Impact on Mortality After Pediatric Heart Transplantation Cecillia Lui, MD, Joshua C. Grimm, MD, J. Trent Magruder, MD, Samuel P. Dungan, BA, Joseph A. Spinner, MD, Nhue Do, MD, Kristin L. Nelson, MD, Duke E. Cameron, MD, Luca A. Vricella, MD, Marshall L. Jacobs, MD The Annals of Thoracic Surgery Volume 100, Issue 4, Pages 1423-1431 (October 2015) DOI: 10.1016/j.athoracsur.2015.06.016 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Number of active institutions stratified by high (diagonal bar), medium (dotted bar), and low (black bar) institutional volume. The Annals of Thoracic Surgery 2015 100, 1423-1431DOI: (10.1016/j.athoracsur.2015.06.016) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Survival stratified by low (solid line), intermediate (dotted line), and high (dashed line) institutional volume. The Annals of Thoracic Surgery 2015 100, 1423-1431DOI: (10.1016/j.athoracsur.2015.06.016) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Postoperative complication rates stratified by low (dark bar), intermediate (medium gray), and high (light gray) institutional volume. There was a significant difference in the incidence of rejection and the composite complication outcome among the cohorts. The Annals of Thoracic Surgery 2015 100, 1423-1431DOI: (10.1016/j.athoracsur.2015.06.016) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Long-term survival stratified by the number of postoperative complications. (0 = solid line; 1 = dotted line; 2 = medium dashed line; ≥3 = large dashed line.) The Annals of Thoracic Surgery 2015 100, 1423-1431DOI: (10.1016/j.athoracsur.2015.06.016) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Mortality subsequent to complications as a function of low (solid line), intermediate (dotted line), and high (dashed line) institutional volume. Five-year survival is shown in patients who experienced the (A) composite complication outcome, (B) renal failure, (C) infection, (D) reoperation, (E) stroke, and (F) rejection stratified by institutional volume. The Annals of Thoracic Surgery 2015 100, 1423-1431DOI: (10.1016/j.athoracsur.2015.06.016) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions