Each year, an estimated 80 000 patients in the United States undergo surgery for correction of aortic valve stenosis.1 Because patients with aortic stenosis are often elderly and have multiple comorbidities, surgical aortic valve replacement (SAVR) is associated with significant morbidity and mortality. The approval by the US Food and Drug Administration (FDA) of transcatheter aortic valve replacement (TAVR) for treatment of patients considered inoperable and the subsequent expansion of the indication to include patients at high risk of SAVR was thus met with enthusiasm. Experts in structural heart disease posited, however, that TAVR could provide high-value care if physicians were able to develop a new set of technical skills, appreciated the limitations and risks associated with the procedure, and judiciously selected patients—goals that could best be achieved by the creation of regional centers of excellence that housed a well-organized team of caregivers with broad expertise in structural and valvular heart disease, cardiovascular imaging, and postprocedure care.2 However, rapid physician adoption, an inability to control the proliferation of its utilization, and a high-cost structure have made TAVR another example of how difficult it may be to bend the cost curve by increasing value in health care through improvement in quality and reduction of health care costs.
Feldman AM, DiSesa VJ. Transcatheter Aortic Valve ReplacementFlattening the Cost Curve. JAMA. 2014;312(1):25-26. doi:10.1001/jama.2014.4606