{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T22:50:23Z","timestamp":1789599023697,"version":"build-2803163510"},"reference-count":19,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>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 &lt;5 mm, no in-hospital major adverse events).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Among 87\u2009480 patients (76.2\u00b18.0 years; 58.8% men; mean CHA\n              <jats:sub>2<\/jats:sub>\n              DS\n              <jats:sub>2<\/jats:sub>\n              -VASc score, 4.8\u00b11.5) 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\u20130.77]) and Q2 (OR, 0.78 [CI, 0.69\u20130.90]) but not Q3 (OR, 0.95 [CI, 0.84\u20131.07]). 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\u20130.82]), Q2 (OR, 0.79 [CI, 0.71\u20130.89]), and Q3 (OR, 0.88 [CI, 0.79\u20130.97]). Among WATCHMAN FLX procedures, there was attenuation of the volume-outcome relationships, with statistically significant but modest absolute differences of only \u22481% across volume quartiles.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>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.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.123.013466","type":"journal-article","created":{"date-parts":[[2024,6,18]],"date-time":"2024-06-18T18:11:28Z","timestamp":1718734288000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Procedure Volume and Outcomes With WATCHMAN Left Atrial Appendage Occlusion"],"prefix":"10.1161","volume":"17","author":[{"given":"Daniel J.","family":"Friedman","sequence":"first","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.J.F., S.V., A.S.K., J.P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengan","family":"Du","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.D., S.Z., Z.T., Z.L., L.P., K.E.M., K.F.F., J.P.C., J.V.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0219-8498","authenticated-orcid":true,"given":"Sarah","family":"Zimmerman","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.D., S.Z., Z.T., Z.L., L.P., K.E.M., K.F.F., J.P.C., J.V.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1288-8526","authenticated-orcid":true,"given":"Zhen","family":"Tan","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.D., S.Z., Z.T., Z.L., L.P., K.E.M., K.F.F., J.P.C., J.V.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhenqiu","family":"Lin","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.D., S.Z., Z.T., Z.L., L.P., K.E.M., K.F.F., J.P.C., J.V.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1599-2957","authenticated-orcid":true,"given":"Sreekanth","family":"Vemulapalli","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.J.F., S.V., A.S.K., J.P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4151-5185","authenticated-orcid":true,"given":"Andrzej S.","family":"Kosinski","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.J.F., S.V., A.S.K., J.P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0772-2404","authenticated-orcid":true,"given":"Jonathan P.","family":"Piccini","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.J.F., S.V., A.S.K., J.P.P.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucy","family":"Pereira","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.D., S.Z., Z.T., Z.L., L.P., K.E.M., K.F.F., J.P.C., J.V.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9063-8272","authenticated-orcid":true,"given":"Karl E.","family":"Minges","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.D., S.Z., Z.T., Z.L., L.P., K.E.M., K.F.F., J.P.C., J.V.F.)."},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (K.E.M., K.F.F., J.P.C., J.V.F.)."},{"name":"Department of Population Health and Leadership, University of New Haven, West Haven, CT (K.E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9276-9110","authenticated-orcid":true,"given":"Kamil F.","family":"Faridi","sequence":"additional","affiliation":[{"name":"Center for Outcomes Research and Evaluation, Yale New Haven Health, CT (C.D., S.Z., Z.T., Z.L., L.P., K.E.M., K.F.F., J.P.C., J.V.F.)."},{"name":"Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT (K.E.M., K.F.F., J.P.C., J.V.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5681-6709","authenticated-orcid":true,"given":"Frederick A.","family":"Masoudi","sequence":"additional","affiliation":[{"name":"Ascension, St. Louis, MO (F.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6872-0501","authenticated-orcid":true,"given":"Jeptha 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