Quality, economics, and national guidelines for transcatheter aortic valve replacement.
Transcatheter aortic valve replacement (TAVR) is a transformative technology for the treatment of aortic stenosis, requiring a multidisciplinary collaboration in the form of a "heart team" that includes interventional cardiologists and cardiac surgeons. As this new technology continues to disperse rapidly, its proper therapeutic role evolves and leads to important questions regarding who should perform the procedure, where it should be performed, and who should pay for it. Herein, we review the most recent guidelines governing the use of TAVR in the United States and Europe. We then summarize the available registry data, which, despite its limitations, presents the clearest picture of TAVR in clinical use. Finally, we discuss the costs and relative cost-effectiveness of TAVR. Taken together, these are the elements from which the larger questions surrounding TAVR must be answered.
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN. Electronic address: pollak.peter@mayo.edu.
Peter M
PM
Pollak
The Heart Hospital Baylor, Plano, TX.
Michael J
MJ
Mack
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN.
David R
DR
Holmes
D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000592:standards; D003362:Cost-Benefit Analysis; D005060:Europe; D017048:Health Care Costs / Q000592:standards; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000295:instrumentation / Q000592:standards; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000191:economics / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards; D019984:Quality Indicators, Health Care / Q000191:economics / Q000592:standards; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
Aortic stenosis; Cost; Cost-effectiveness; National guidelines; Quality; Transcatheter aortic valve replacement