Median Operative Mortality Rates for Specific Surgical Procedures (STS Adult Cardiac Surgery Database, 2019) Procedure Mortality Rate (%) AVR and CABG 4 AVR and mitral valve replacement 9 Mitral valve replacement 5 Mitral valve replacement and CABG 9 Mitral valve repair 1 Mitral valve repair and CABG 5 AVR indicates aortic valve replacement; CABG, coronary artery bypass graft surgery; and STS, Society of Thoracic Surgeons. CLINICAL STATEMENTS AND GUIDELINES Table 11. Structure of Primary and Comprehensive Valve Centers Comprehensive (Level I) Valve Center Primary (Level II) Valve Center Interventional procedures* TAVI transfemoral TAVI transfemoral Percutaneous aortic valve balloon dilation Percutaneous aortic valve balloon dilation TAVI alternative access, including transthoracic (transaortic, transapical) and extrathoracic (eg, subclavian, carotid, caval) approaches Valve-in-valve procedures TEER Prosthetic valve paravalvular leak closure Percutaneous mitral balloon commissurotomy Surgical procedures* SAVR SAVR Valve-sparing aortic root procedures Aortic root procedures for aneurysmal disease Concomitant septal myectomy with AVR Root enlargement with AVR Mitral repair for primary MR Mitral repair for posterior leaflet primary MR Mitral valve replacement Mitral valve replacement Multivalve operations Reoperative valve surgery Isolated or concomitant tricuspid valve repair or replacement Concomitant tricuspid valve repair or replacement with mitral surgery Imaging personnel Echocardiographer with expertise in valve disease and transcatheter and surgical interventions Echocardiographer with expertise in valve disease and transcatheter and surgical interventions Expertise in CT with application to valve assessment and procedural planning Expertise in CT with application to valve assessment and procedural planning Interventional echocardiographer to provide imaging guidance for transcatheter and intraoperative procedures Expertise in cardiac MRI with application to assessment of VHD Criteria for imaging personnel A formalized role/position for a valve echocardiographer who performs both the pre- and postprocedural assessment of valve disease A formalized role/position for a valve echocardiographer who performs both the pre- and postprocedural assessment of valve disease A formalized role/position for the expert in CT who oversees the preprocedural assessment of patients with valve disease A formalized role/position for the expert in CT who oversees the preprocedural assessment of patients with valve disease A formalized role/position for an interventional echocardiographer Institutional facilities and infrastructure MDT MDT A formalized role/position for a dedicated valve coordinator who organizes care across the continuum and system of care A formalized role/position for a dedicated valve coordinator who organizes care across the continuum and system of care Cardiac anesthesia support Cardiac anesthesia support Palliative care team Palliative care team Vascular surgery support Vascular surgery support Neurology stroke team Neurology stroke team Consultative services with other cardiovascular subspecialties Consultative services with other medical and surgical subspecialties Echocardiography 3D TEE; comprehensive TTE for assessment of valve disease Echocardiography comprehensive TTE for assessment of valve disease Cardiac CT Cardiac CT ICU ICU (Continued) CLINICAL STATEMENTS AND GUIDELINES Recommendation-Specific Supportive Text 1. 