A new study suggests that while hospital-level associations between procedural volume and outcomes for transcatheter valve therapies may be plateauing, an operator's individual experience remains a significant factor. An analysis of a large US registry found a persistent inverse association between operator volume and patient outcomes for both transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (MTEER).¹

Methodology

This cohort study analysed data from the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) Transcatheter Valve Therapies (TVT) Registry. It included consecutive patients undergoing TAVR for aortic stenosis or MTEER for mitral regurgitation between January 2020 and December 2023. The final cohort comprised 358,943 patients undergoing TAVR at 827 hospitals and 51,407 patients undergoing MTEER at 493 hospitals.¹

Operators were categorised by annual procedural volume into low, medium, and high tertiles. The primary outcomes were 30-day all-cause mortality, a 30-day composite outcome, and in-hospital procedural complications.

Results

For TAVR, low-volume operators (<15 procedures/year) were associated with a higher risk of 30-day mortality (odds ratio [OR], 1.13; 95% CI, 1.02–1.26; p=0.02) and in-hospital complications (OR, 1.09; 95% CI, 1.03–1.16; p=0.005) compared with high-volume operators (>37 procedures/year). Low-volume operators also demonstrated longer procedure times and greater contrast use.¹

For MTEER, low-volume operators (<8 procedures/year) had a higher rate of in-hospital complications (OR, 1.31; 95% CI, 1.11–1.56; p=0.002) and the 30-day composite outcome (OR, 1.12; 95% CI, 1.03–1.21; p=0.007) compared with high-volume operators (>16 procedures/year). There was no statistically significant difference in 30-day mortality between the groups.¹

These associations between operator volume and outcomes were consistent across all strata of hospital procedural volumes.

In Practice/Interpretation

The findings highlight that despite the maturation of these technologies and a potential plateauing of the hospital volume-outcome relationship, individual operator experience continues to influence short-term results.² The study authors concluded that the “results from a large, contemporary US registry demonstrate a persistent inverse association between operator volume and patient outcomes for both TAVR and MTEER.”¹ They suggest these findings may help inform future policies aimed at ensuring optimal outcomes as the number of sites and operators continues to expand.

Next Steps

The authors noted that longer-term studies on the relationship between transcatheter procedure volumes and outcomes will be important to pursue to further inform future policies.

This study was funded by Cytokinetics, Edwards Lifesciences, the US Food and Drug Administration, and the US National Institutes of Health.

References

1. Kumbhani DJ, Girotra S, Dong H, et al. Contemporary Operator Procedural Volumes and Outcomes for TAVR and MTEER in the US. JAMA Cardiol. 2026. https://doi.org/10.1001/jamacardio.2025.5645

2. Kumbhani DJ, Manandhar P, Bavry AA, et al. National variation in hospital MTEER outcomes and correlation with TAVR outcomes: STS/ACC TVT Registry analysis. JACC Cardiovasc Interv. 2024;17(4):505-515. https://doi.org/10.1016/j.jcin.2023.11.012

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