Contemporary Operator Procedural Volumes and Outcomes for TAVR and MTEER in the US

Importance 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–outcomes association in the contemporary era. Objective To determine whether an operator-level volume-outcomes association exists for TAVR and MTEER in the contemporary era. Design, Setting, and Participants 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. Exposure TAVR or MTEER. Main Outcomes and Measures 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. Results A total of 358 943 patients underwent TAVR at 827 hospitals (7524 operators; median [IQR] annual volume, 24 [11-47]), and 51 407 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 152 186 patients (42.4%) were female; for MTEER, median (IQR) patient age was 79.0 (71.0-84.0) years, and 23 402 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; P =.02) and in-hospital complications (OR, 1.09; 95% CI, 1.03-1.16; P =.005) was observed for low-volume TAVR operators (<15/y) compared with high-volume operators (>37/y). For MTEER, in-hospital complications (OR, 1.31; 95% CI, 1.11-1.56; P =.002) were higher for low-volume operators (<8/y) compared with high-volume operators (>16/y), while 30-day mortality was not different (OR, 1.16; 95% CI, 0.96-1.41; P =.12). Associations were consistent across hospital volume strata. Operator-level outcomes for TAVR and MTEER were not correlated. Conclusions and Relevance 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.