There is a substantial body of literature to support a relationship between institutional vol- ume and mortality rate for many cardiovascular procedures, including SAVR,1 5 and surgi- cal mitral valve repair.7 11 Consideration should be given to consultation with or referral to a Primary or Comprehensive Heart Valve Center for asymp- tomatic patients with severe VHD. Although excellent outcomes certainly can be achieved at lower-volume centers, assurance of outcomes equivalent to those of a higher-volume center is statistically more challenging.12 Similarly, for patients with multiple comorbidities for whom multispecialty collaboration is anticipated, care at a Comprehensive or Primary Valve Center ensures optimal outcomes. Although findings are mixed,13 there are data to support relationships between center volume and complication rates in cardiac between center volume and fail- ure to rescue after procedural complications,15 17 and between center volume and elements of 2.7. Management of Patients With VHD After Valve Intervention Interventions in patients with VHD include both trans- catheter and surgical approaches. A valve interven- tion leaves the patient with either a prosthetic valve or a valve repair, often with an implanted device or other prosthetic material. Valve intervention does not eliminate valve disease; it replaces native valve disease with palliated valve disease. 