Heart valve floating in data streams with scales in background, symbolizing balanced quality assessment.

TAVR: Are We Really Measuring Quality?

Soraya Malik in Health & Wellness July 2025 • 4 min read.

"A critical look at how we assess transcatheter aortic valve replacement and what really matters for patients."

For years, healthcare quality has been assessed using a simple framework: structure, process, and outcome. This model, developed by Dr. Avedis Donabedian, helps us understand if the context of care (structure), the actions taken (process), and the results achieved (outcome) are all contributing to a patient's well-being. Think of it like baking a cake: you need the right kitchen (structure), a good recipe (process), and a delicious cake as the final result (outcome).

In the world of heart procedures, specifically transcatheter aortic valve replacement (TAVR), this framework is still evolving. Initially, the focus was on structural measures, like the number of TAVR procedures a hospital performed. Now, there's a growing need to look at more meaningful outcomes for patients, moving beyond just whether they survived the procedure.

This article dives into the current state of quality assessment in TAVR, highlighting a recent study that questions whether we're truly capturing what matters most to patients. We'll explore why simply counting procedures or tracking mortality rates might not be enough and what other factors, like procedural complications and patient-reported quality of life, should be considered.

Beyond Volume: What Truly Defines Quality in TAVR?

Heart valve floating in data streams with scales in background, symbolizing balanced quality assessment.

For a while, TAVR volume was seen as a key indicator of quality. The idea was simple: more experience equals better outcomes. In fact, in the United States, TAVR volume has been used as a requirement for hospitals to even offer the procedure.

However, focusing solely on volume has its limitations. While it's easy to measure, it doesn't necessarily translate to better patient outcomes. Quality assessment groups have long recognized that structural measures, like volume, are essentially stand-ins for what we really care about: how the patient is doing.

Easy to Measure, But Is It Meaningful?: Structural measures like volume are simple to track, but they don't always reflect the actual quality of care.
Surrogate Metrics: Volume acts as a substitute for true patient outcomes.
The Ideal Feature: The perfect structural measure would be a clear link between volume and positive patient outcomes.

So, while TAVR volume might get a program off the ground, the real challenge is to assess those outcomes and the processes that drive them.

The Future of TAVR Quality: Focusing on What Matters

The push is on to move beyond just counting procedures and tracking mortality. As TAVR becomes more commonplace, and techniques improve, simply looking at survival rates might not be enough to differentiate between high-performing and average-performing centers.

This means focusing on things like procedural complications, which are a major concern for both doctors and patients. Also, listening to patients and measuring their quality of life after the procedure becomes essential.

To truly improve TAVR quality, we need a multi-faceted approach: continued data collection, better ways to predict risk, and a focus on the processes that lead to the best possible outcomes for each and every patient.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1161/circoutcomes.118.005233, Alternate LINK

Title: Transcatheter Aortic Valve Replacement In The Era Of Quality Assessment

Subject: Cardiology and Cardiovascular Medicine

Journal: Circulation: Cardiovascular Quality and Outcomes

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Taku Inohara, Sreekanth Vemulapalli

Published: 2018-12-01

Everything You Need To Know

What is the Donabedian model and how does it apply to assessing the quality of TAVR?

The Donabedian model provides a framework that looks at healthcare quality through three lenses: structure, process, and outcome. 'Structure' refers to the resources and infrastructure available, like hospital facilities and equipment. 'Process' involves the actions taken during treatment, such as how a TAVR procedure is performed. 'Outcome' measures the results of the treatment, like patient survival and quality of life. The model emphasizes that all three components are essential for ensuring high-quality care. Although useful, it doesn't show relative importance.

Why was TAVR volume initially considered a key indicator of quality, and what are its limitations?

Initially, TAVR volume was used as a key indicator, based on the assumption that more experience leads to better results. However, it's a structural measure and easy to quantify but doesn't always reflect true patient outcomes. While volume can help establish a TAVR program, focusing solely on it may not accurately capture the quality of care provided or address variations in procedural complications and patient-reported outcomes.

Besides mortality rates, what other factors should be considered when assessing TAVR quality?

While mortality rates are important, they might not be sufficient to differentiate between high-performing and average centers as TAVR techniques improve and become more commonplace. The focus is shifting towards patient-centered outcomes, such as procedural complications, patient-reported quality of life, and other factors that truly impact a patient's well-being after the procedure. Simply surviving doesn't mean the patient is living well. A comprehensive assessment should include these broader measures to provide a more accurate picture of TAVR quality.

What would be considered an ideal feature of a structural measure like TAVR volume?

A good structural measure provides a clear and direct link between volume and positive patient outcomes. The ideal feature is that higher TAVR volume definitively translates to improved patient well-being, reduced complications, and enhanced quality of life. However, in practice, this direct correlation is not always evident, as volume alone doesn't guarantee better outcomes. The focus should be on identifying structural measures that reliably predict and contribute to patient-centered results.

What does it mean to focus on patient-centered outcomes in TAVR, and why is it important?

Focusing on patient-centered outcomes means prioritizing what truly matters to patients, such as their quality of life, functional status, and the absence of procedural complications after TAVR. This approach involves actively gathering and incorporating patient feedback, using standardized questionnaires and assessments to measure outcomes beyond just survival rates. By focusing on these factors, healthcare providers can gain a more complete understanding of the impact of TAVR on patients' lives and identify areas for improvement in their care.