Counterpoint: Access to transcatheter aortic valve replacement should not be limited to high-volume surgical centers

Abstract

Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis in high-risk older adults in Europe and has begun to do so in the United States. Recent Food and Drug Administration approval of the Edwards Lifesciences SAPIEN Transcatheter Heart Valve (Irvine, Calif) in inoperable and high-risk patients led to enthusiasm for widespread implementation of this technology. Experts have highlighted the central role of the multidisciplinary heart team in implementing a successful TAVR program. Other experts, such as Joseph Bavaria, have suggested that access to TAVR should be restricted to high-volume surgical aortic valve replacement centers. In our opinion, access to TAVR should not be limited to high-volume surgical centers for the following reasons. First, high surgical volume does not ensure good outcomes in complex interventional procedures. Second, centers with low or no surgical volume can have excellent interventional results. Third, new multidisciplinary heart teams have achieved excellent results in part because of the transmission of accumulated knowledge from experienced centers. Finally, in the absence of evidence suggesting that high-volume surgical centers produce superior TAVR results, therapeutic options for patients should not be limited.