Transcatheter aortic valve replacement program development: recommendations for best practice.
BACKGROUND
Transcatheter aortic valve replacement (TAVR) is an increasingly available therapy for the management of aortic stenosis in higher risk populations. Beyond addressing the procedural challenges, centers must attend to the unique requirements of developing TAVR programs from referral to follow-up.


OBJECTIVE
The aim of this article is to outline the recommendations for best practice for program development from centers with early and extensive experience.


CONCLUSIONS
The guideline-recommended Heart Team approach requires interdisciplinary agreements, delineation of roles and responsibilities, and the development of the role of the TAVR Coordinator. To support appropriate case selection, the screening and evaluation must be organized in a comprehensive clinic visit. In addition to the multimodality imaging tests, the assessment of functional status and frailty is pivotal to the eligibility decision. Throughout the TAVR trajectory, careful attention must be afforded to the integration of geriatric best practices. Pre-procedure care requires patient and family education to manage expectations and facilitate early discharge planning. Peri-procedural care planning, including equipment requirements, monitoring protocols, and emergency intervention agreements, contributes to procedural success. The aims of post-procedure care are to monitor the recovery, facilitate the rapid return to baseline status, and optimize length of stay. TAVR programs require data management strategies to facilitate and monitor program growth, support program evaluation, and meet the requirements for submission to national registries.


CONCLUSIONS
TAVR represents a paradigm shift in the management of structural heart disease. Programmatic success and patient outcomes depend on the development of a comprehensive and collaborative program tailored to TAVR.
New York Presbyterian/Columbia University Medical Center, New York, New York.
Marian C
MC
Hawkey
Sandra B
SB
Lauck
Elizabeth M
EM
Perpetua
Jill
J
Fowler
Susan
S
Schnell
Martina
M
Speight
Karen Holst
KH
Lisby
John G
JG
Webb
Martin B
MB
Leon
D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000628:therapy*; D019985:Benchmarking / Q000592:standards*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D003299:Cooperative Behavior; D003952:Diagnostic Imaging / Q000592:standards; D004608:Eligibility Determination / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000592:standards*; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team / Q000592:standards; D011237:Predictive Value of Tests; D016730:Program Development / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D016896:Treatment Outcome
aortic valve disease; percutaneous intervention; program development; transcatheter valve replacement