{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:48:05Z","timestamp":1791391685201,"version":"4.3.3"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"19","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,10,6]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The relationship between institutional volume and transcatheter aortic valve replacement outcomes is complex but vital for optimizing patient triage and developing effective care strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">The authors analyzed outcomes of patients undergoing transcatheter aortic valve replacement between January 2021 and February 2023 in the STS\/ACC TVT (Society of Thoracic Surgeons\/American College of Cardiology Transcatheter Valve Therapy) Registry at hospitals affiliated with the CommonSpirit Health network. Centers were categorized by annual TAVR volume as low (&lt;100 cases per year), intermediate (100\u2013300 cases per year), or high (&gt;300 cases per year). Baseline risk assessment included the Society of Thoracic Surgeons score, an estimate of operative mortality risk. The primary outcome was major adverse cardiac and cerebrovascular events. Inverse probability of treatment weighting adjusted for baseline differences.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among 6663 patients, 58.6% were treated at high\u2010volume centers. Patients treated at high\u2010volume centers were older than those at intermediate\u2010 or low\u2010volume centers (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001). STS risk scores were highest at high\u2010volume centers than at intermediate\u2010 and low\u2010volume centers (\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.005). After inverse probability of treatment weighting adjustment, high\u2010volume centers remained associated with a reduced risk of major adverse cardiac and cerebrovascular events compared with both low\u2010volume centers (adjusted hazard ratio [aHR], 0.40 [95% CI, 0.16\u20130.98];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.047) and intermediate\u2010volume centers (aHR, 0.56 [95% CI, 0.34\u20130.92];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.021). Receiver operating characteristic analysis identified an annual procedural volume threshold of 314 cases as the empirical discriminator of MACCE (area under the curve, 0.77 [95% CI, 0.74\u20130.80];\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Within this integrated health system, high\u2010volume centers had better risk\u2010adjusted outcomes despite treating higher\u2010risk patients. The empiric volume threshold identified in this cohort should be validated in other settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.126.050694","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T04:24:09Z","timestamp":1788150249000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Institutional Volume Thresholds and Risk\u2010Adjusted Outcomes After Transcatheter Aortic Valve Replacement: Contemporary Evidence From the Society of Thoracic Surgeons\/American College of Cardiology Transcatheter Valve Therapy Registry"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5294-3682","authenticated-orcid":false,"given":"Sant","family":"Kumar","sequence":"first","affiliation":[{"name":"Creighton University","place":["Phoenix, USA"]},{"name":"St. Joseph Hospital and Medical Center","place":["Phoenix, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6424-4341","authenticated-orcid":false,"given":"Ashish","family":"Pershad","sequence":"additional","affiliation":[{"name":"Creighton University","place":["Phoenix, USA"]},{"name":"St. Joseph Hospital and Medical Center","place":["Phoenix, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hursh","family":"Naik","sequence":"additional","affiliation":[{"name":"Creighton University","place":["Phoenix, USA"]},{"name":"St. Joseph Hospital and Medical Center","place":["Phoenix, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0177-4791","authenticated-orcid":false,"given":"Nezar","family":"Falluji","sequence":"additional","affiliation":[{"name":"Creighton University","place":["Phoenix, USA"]},{"name":"St. Joseph Hospital and Medical Center","place":["Phoenix, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2020.09.595"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab773"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.02.042"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2024.3453"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2018.06.044"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa1901109"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2025.5645"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2018.07.002"},{"key":"e_1_3_1_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2013.03.060"},{"key":"e_1_3_1_11_2","unstructured":"NCD \u2010 transcatheter aortic valve replacement (TAVR) (20.32). Accessed November 26 2025. https:\/\/www.cms.gov\/medicare\u2010coverage\u2010database\/view\/ncd.aspx?ncdid=355&ncdver=2&NCAid=257&ver=4&NcaName=Transcatheter+Aortic+Valve+Replacement+(TAVR)&bc=ACAAAAAACAAAAA%3D%3D."},{"key":"e_1_3_1_12_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.1474"},{"key":"e_1_3_1_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2007.11.008"},{"key":"e_1_3_1_14_2","unstructured":"Data Collection. Accessed December 2 2024. https:\/\/www.ncdr.com\/WebNCDR\/tvt\/publicpage\/data\u2010collection."},{"key":"e_1_3_1_15_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehq406"},{"key":"e_1_3_1_16_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.018610"},{"key":"e_1_3_1_17_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.1460"},{"key":"e_1_3_1_18_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.1143"},{"key":"e_1_3_1_19_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.120.021350"},{"key":"e_1_3_1_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jscai.2022.100457"},{"key":"e_1_3_1_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2019.09.048"},{"key":"e_1_3_1_22_2","doi-asserted-by":"publisher","DOI":"10.21037\/jtd-2025-802"},{"key":"e_1_3_1_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00494-6"},{"key":"e_1_3_1_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwj149"},{"key":"e_1_3_1_25_2","doi-asserted-by":"publisher","DOI":"10.7326\/M16-2607"},{"key":"e_1_3_1_26_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2025.17274"},{"key":"e_1_3_1_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-098569"},{"key":"e_1_3_1_28_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.1630"},{"key":"e_1_3_1_29_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2020.07.068"},{"key":"e_1_3_1_30_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2017.04.056"},{"key":"e_1_3_1_31_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2019.08.999"},{"key":"e_1_3_1_32_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.035719"},{"key":"e_1_3_1_33_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2023.0477"}],"container-title":["Journal of the American Heart Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/JAHA.126.050694","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T06:25:46Z","timestamp":1791354346000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/JAHA.126.050694"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,6]]},"references-count":32,"journal-issue":{"issue":"19","published-print":{"date-parts":[[2026,10,6]]}},"alternative-id":["10.1161\/JAHA.126.050694"],"URL":"https:\/\/doi.org\/10.1161\/jaha.126.050694","relation":{},"ISSN":["2047-9980"],"issn-type":[{"value":"2047-9980","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,6]]},"assertion":[{"value":"2026-03-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-30","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e050694"}}