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Invited Commentary
January 2019

Has a New Determinant of Transcatheter Aortic Valve Replacement Outcomes Been Identified?

Author Affiliations
  • 1Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora
JAMA Cardiol. 2019;4(1):22-24. doi:10.1001/jamacardio.2018.4170

There has been much recent attention to the quality of care delivered by transcatheter aortic valve replacement (TAVR) programs, including whether the experience of the team is an important determinant of quality. Experience can be expressed as the duration of a program being open and the volume of procedures the team have performed. If a clinically meaningful association between volume and outcome is redemonstrated using data from the current era of new technologies and expanding indications, then this could influence professional societies’ guidelines, expert consensus documents, and government policy decisions. Specifically, the national coverage analysis for TAVR is now being performed by the Centers for Medicare and Medicaid, after they reopened the national coverage decision on June 27, 2018.1 The Centers for Medicare and Medicaid has gathered input from a recent Medicare Evidence Development and Coverage Advisory Committee meeting and written submissions during the initial public comment period. The national coverage analysis has an expected completion date of June 25, 2019, and it could result in an updated national coverage decision that includes requirements for clinicians and sites to qualify for coverage of TAVR.1 The recently published professional society document2 does recommend a surgical aortic valve replacement (SAVR) volume threshold and a recommendation that TAVR sites must achieve an acceptable SAVR outcomes metric.

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