This paper summarizes the implications of recent TAVR program expansion, supports the 2019 multisociety expert consensus recommendation of Level 1 and Level 2 valve centers, and defines the important role of hospitals without on-site TAVR procedural capabilities.
Background
TAVR therapy was first performed in select tertiary medical centers across the US during its 10-year investigative phase. Even prior to FDA approval in 2011, the therapy had gained a high level of interest among interventional cardiologists, cardiothoracic surgeons, and cardiovascular (CV) leaders as a novel and less invasive alternative to open-heart surgery.
Current Growth Patterns
New TAVR program development has gravitated toward more densely populated communities, resulting in clusters of competing programs (figure 2).
As of 2021, 98.0% of new TAVR programs had been established in metropolitan areas, and 52.9% were started in metropolitan areas with existing TAVR programs.4 The city of Houston, for example, has nine TAVR programs competing for volume, and six US cities have six or more programs each. This regional density often translates into lower case volumes per hospital, and it challenges programs to maintain both clinical expertise and financial margins.
Published September 8, 2022
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