{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T19:04:28Z","timestamp":1765911868171,"version":"3.48.0"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The dissemination of novel procedures should attempt to strike a balance between access and procedure quality. This study aimed to evaluate the temporal trends and geographic dispersion of mitral transcatheter edge-to-edge repair (M-TEER) sites and to examine the associations of site volume and site-to-population density with patient outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>We used the Medicare administrative databases in the United States to identify sites performing M-TEER in patients aged 65 to 99 years from 2017 to 2020 and examined the annualized volume and site-to-population density (per million beneficiaries in each corresponding hospital referral region). A hierarchical Cox regression analysis accounting for site-level clustering was performed to assess the association of site volume and density with 30-day and 1-year all-cause mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>We identified 456 sites performing M-TEER in 16\u2009810 patients (median [interquartile range] age, 81 [75\u201386] years; female, 47%). The case number of M-TEER increased by 54% from 3125 in 2017 to 4820 in 2020, while sites performing M-TEER increased by 71% from 252 in 2017 to 432 in 2020, corresponding to a decline in the median patient-to-site distances from 37.1 kilometers (interquartile range, 14.4\u2013105.0) to 28.6 kilometers (interquartile range, 12.8\u201374.9). Higher site volume (every 10 cases\/y) was associated with lower 30-day (adjusted hazard ratio, 0.94 [95% CI, 0.91\u20130.99]) and 1 year (adjusted hazard ratio, 0.98 [95% CI, 0.96\u20131.00]) mortality, while there was insufficient evidence to determine the association between higher site density (every 1 site\/million-beneficiaries) and 30-day (adjusted hazard ratio, 1.00 [95% CI, 0.99\u20131.02]) and 1-year (adjusted hazard ratio, 1.00 [95% CI, 0.99\u20131.01]) mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Although sites performing M-TEER have been rapidly expanding, we did not find associations between higher regional site density and patient mortality. Continuous careful planning in disseminating M-TEER while ensuring adequate procedure volume per site may optimize patient outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circoutcomes.125.012134","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T09:00:06Z","timestamp":1761901206000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Uptake, Geographic Access, and Outcomes of Transcatheter Mitral Valve Repair in the United States"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8781-0329","authenticated-orcid":true,"given":"Atsuyuki","family":"Watanabe","sequence":"first","affiliation":[{"name":"Department of Medicine, Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY (A.W.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroki A.","family":"Ueyama","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Emory University School of Medicine, Atlanta, GA (H.A.U.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2852-2946","authenticated-orcid":true,"given":"Yoshihisa","family":"Miyamoto","sequence":"additional","affiliation":[{"name":"Department of Real-world Evidence, Graduate School of Medicine, The University of Tokyo, Japan (Y.M.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4238-0171","authenticated-orcid":true,"given":"Hiroshi","family":"Gotanda","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA (H.G.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6500-7471","authenticated-orcid":true,"given":"Tsuyoshi","family":"Kaneko","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, MO (T. Kaneko)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9035-343X","authenticated-orcid":true,"given":"Azeem","family":"Latib","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, NY (A.L.)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7107-3667","authenticated-orcid":true,"given":"Dhaval","family":"Kolte","sequence":"additional","affiliation":[{"name":"Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (D.K., S.J.B., T. Kuno)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8319-5637","authenticated-orcid":true,"given":"Suzanne J.","family":"Baron","sequence":"additional","affiliation":[{"name":"Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston (D.K., S.J.B., T. Kuno)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3861-3163","authenticated-orcid":true,"given":"Eric","family":"Secemsky","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.S., R.J.L., T. Kuno)."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8336-3779","authenticated-orcid":true,"given":"Roger J.","family":"Laham","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (E.S., R.J.L., T. 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