Valve intervention does not eliminate valve disease; it replaces native valve disease with palliated valve disease. Patients with VHD con- tinue to require periodic evaluation after intervention Temporary mechanical support (including percutaneous support devices such as intra-aortic balloon counterpulsation, temporary percutaneous ventricular assist device or ECMO) Temporary mechanical support (including percutaneous support devices such as intra-aortic balloon counterpulsation, temporary percutaneous ventricular assist device or ECMO) Left/right ventricular assist device capabilities (on-site or at an affiliated institution) Cardiac catheterization laboratory, hybrid catheterization laboratory, or hybrid OR laboratory Cardiac catheterization laboratory PPM and ICD implantation PPM and ICD implantation Criteria for institutional facilities and infrastructure IAC echocardiography laboratory accreditation IAC echocardiography laboratory accreditation 24/7 intensivist coverage for ICU *A primary (Level II) Center may provide additional procedures traditionally offered at a Comprehensive (Level I) Center as long as the criteria for competence and outcomes are met. If intraoperative imaging and surgical expertise exist. If mitral valve anatomy is not suitable for valve repair. Equipped with a fixed radiographic imaging system and flat-panel fluoroscopy, offering catheterization laboratory-quality imaging and hemodynamic capability. AVR indicates aortic valve replacement; CT, computed tomography; ECMO, extracorporeal membrane oxygenation; ICD, implantable cardioverter defibrillator; IAC, Intersocietal Accreditation Commission; ICU, intensive care unit; MDT, multidisciplinary team; MR, mitral regurgitation; MRI, magnetic resonance imaging; OR operating room; PPM, permanent pacemaker; SAVR, surgical aortic valve replacement; TAVI, transcatheter aortic valve implantation; TEE, transesophageal echocardiography; TEER, transcatheter edge-to-edge repair; TTE, transthoracic echocardiography; VHD, valvular heart disease; and ViV, valve-in-valve. Used with permission from Nishimura et al.12 Table 11. Continued Comprehensive (Level I) Valve Center Primary (Level II) Valve Center CLINICAL STATEMENTS AND GUIDELINES for early postprocedural issues, long-term medical therapy, monitoring of the prosthetic valve or repair, management of concurrent cardiac conditions, and persistent symptoms or functional limitation. 