In a recent Expert Consensus Systems of Care Document,¹ lead authors Dr. Rick A. Nishimura and Dr. Patrick T. O'Gara, on behalf of the committee, proposed a tiered structure for valve centers. Last month's poll sought to assess respondents' feelings about the proposed tiered approach because several public sites had suggested some operators were not happy with the concept.

The results of this poll reflect that greater than half of respondents were not in agreement with a tiered concept. Limitations of the poll include, of course, the small number of respondents and the potential that those with the strongest negative opinions are more likely to respond. All that aside, attempts to limit any procedure, particularly based on procedure volumes, are generally opposed by centers doing lower volumes that claim to have equivalent outcomes and clinicians who feel that such restrictions may place undue stress on patients who may have to travel to distant facilities with larger volumes. However, data exist supporting a volume-outcome concept based on a minimum of 200 cases of transcatheter aortic valve replacement.²

In summary, this poll highlighted what is a frequent area of disagreement about volume statistics and not outcomes as a method of categorizing or limiting qualification status.

Comments are welcome.

References

1. Nishimura RA, O'Gara PT, Bavaria JE, et al. 2019 AATS/ACC/ASE/SCAI/STS Expert Consensus Systems of Care Document: A Proposal to Optimize Care for Patients With Valvular Heart Disease: A Joint Report of the American Association for Thoracic Surgery, American College of Cardiology, American Society of Echocardiography, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2019;73:2609-35.
2. Russo MJ, McCabe JM, Thourani VH, et al. Case Volume and Outcomes After TAVR With Balloon-Expandable Prostheses: Insights From TVT Registry. J Am Coll Cardiol 2019;73:427-40.

Keywords: Transcatheter Aortic Valve Replacement, Aortic Valve, Heart Valve Prosthesis, Coronary Angiography

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