Implementation Issues for Transcatheter Aortic Valve Implantation: Access, Value, Affordability, and Wait Times

  • Harindra C. WijeysunderaEmail author
  • Gabby Elbaz-Greener
  • Derrick Y. Tam
  • Stephen E. Fremes


Transcatheter aortic valve replacement (TAVR) has rapidly transitioned from an innovative procedure intended for compassionate use to the standard of care for elderly patients with severe aortic stenosis. With the growth in the indications for TAVR, demand for this procedure has grown exponentially. This growth has put pressure on funding and infrastructure. In this chapter, we examine these implementation issues through an examination of disparities in access to TAVR, reimbursement concerns related to TAVR value and affordability, the impact of the imbalance between demand and supply in terms of wait times, the consequences of prolonged wait times, and finally the complexities associated with addressing infrastructure limitations.


Implementation TAVR Wait times Affordability Cost drivers Mortality Hospitalization Volume-outcome 


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Harindra C. Wijeysundera
    • 1
    • 2
    • 3
    Email author
  • Gabby Elbaz-Greener
    • 1
  • Derrick Y. Tam
    • 2
    • 4
  • Stephen E. Fremes
    • 2
    • 4
  1. 1.Division of Cardiology, Department of Medicine, Schulich Heart Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  2. 2.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  3. 3.Institute for Clinical Evaluative Sciences (ICES)TorontoCanada
  4. 4.Division of Cardiac Surgery, Department of Surgery, Schulich Heart Centre, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada

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