{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T04:48:31Z","timestamp":1794286111352,"version":"4.9.0"},"reference-count":34,"publisher":"American Medical Association (AMA)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Cardiol"],"published-print":{"date-parts":[[2026,3,1]]},"abstract":"\n Importance<\/jats:title>\n Recent evidence suggests that hospital-level associations between procedural volume and outcomes for transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER) may be plateauing. Less is known about the operator volumes\u2013outcomes association in the contemporary era.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine whether an operator-level volume-outcomes association exists for TAVR and MTEER in the contemporary era.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This cohort study examined data from patients undergoing TAVR or MTEER between January 2020 and December 2023 included in the Society of Thoracic Surgeons (STS)\/American College of Cardiology (ACC) Transcatheter Valve Therapies (TVT) Registry, a national all-comers real-world registry. Consecutive patients undergoing TAVR for aortic stenosis or MTEER for mitral regurgitation were included. Data analysis was performed from October 2024 to December 2025.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n TAVR or MTEER.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome measures were (1) 30-day all-cause mortality, (2) a 30-day composite outcome, and (3) in-hospital procedural complications following TAVR or MTEER. Data from the STS\/ACC TVT Registry were analyzed for patients undergoing TAVR or MTEER between 2020 and 2023. The primary analysis assessed the association between operator volume and 30-day outcomes using a 2-level random-effects logistic regression model. The interaction between operator and hospital volumes and the association between TAVR and MTEER outcomes were also evaluated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 358\u202f943 patients underwent TAVR at 827 hospitals (7524 operators; median [IQR] annual volume, 24 [11-47]), and 51\u202f407 patients underwent MTEER at 493 hospitals (2483 operators; median [IQR] annual volume, 12 [7-19]). For TAVR, median (IQR) patient age was 79.0 (73.0-85.0) years, and 152\u202f186 patients (42.4%) were female; for MTEER, median (IQR) patient age was 79.0 (71.0-84.0) years, and 23\u202f402 patients (45.5%) were female. Low-volume operators demonstrated inferior process of care measures compared with high-volume operators. In adjusted analyses, a higher risk of 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.02-1.26;\n P<\/jats:italic>\n \u2009=\u2009.02) and in-hospital complications (OR, 1.09; 95% CI, 1.03-1.16;\n P<\/jats:italic>\n \u2009=\u2009.005) was observed for low-volume TAVR operators (&amp;lt;15\/y) compared with high-volume operators (&amp;gt;37\/y). For MTEER, in-hospital complications (OR, 1.31; 95% CI, 1.11-1.56;\n P<\/jats:italic>\n \u2009=\u2009.002) were higher for low-volume operators (&amp;lt;8\/y) compared with high-volume operators (&amp;gt;16\/y), while 30-day mortality was not different (OR, 1.16; 95% CI, 0.96-1.41;\n P<\/jats:italic>\n \u2009=\u2009.12). Associations were consistent across hospital volume strata. Operator-level outcomes for TAVR and MTEER were not correlated.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, results from a large, contemporary US registry demonstrate a persistent inverse association between operator volume and patient outcomes for both TAVR and MTEER. These findings may help inform future policies aimed at ensuring optimal outcomes.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamacardio.2025.5645","type":"journal-article","created":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T16:00:45Z","timestamp":1767888045000},"page":"268","source":"Crossref","is-referenced-by-count":14,"title":["Contemporary Operator Procedural Volumes and Outcomes for TAVR and MTEER in the US"],"prefix":"10.1001","volume":"11","author":[{"given":"Dharam J.","family":"Kumbhani","sequence":"first","affiliation":[{"name":"Division of Cardiology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saket","family":"Girotra","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Texas Southwestern Medical Center, Dallas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huaying","family":"Dong","sequence":"additional","affiliation":[{"name":"Richard A. and Susan F. 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