Structural heart disease: one valve does not fit all.

PURPOSE OF REVIEW: Highlight the difficulties patients, physicians, and the global economy face in relation to treatment of structural heart diseases. It is easy to be carried away by the excitement of medical advancement; however, it is difficult to demonstrate restraint. Transcatheter aortic valve replacement (TAVR) is a modern marvel that can help many patients when utilized appropriately. This article highlights the work that has been done to facilitate decision-making in this challenging patient population.

RECENT FINDINGS: Patient selection is of paramount importance as TAVR remains a costly intervention. Currently, our gold standards for preprocedural patient evaluation are inadequate. Apropos, several objective tools are being developed to help clinicians evaluate frailty. Giving patients a more accurate postprocedure prognosis allows them to make informed decisions on whether this intervention is appropriate for their respective goals.

SUMMARY: In order for us to fully embrace shared decision-making and cost-effectiveness, we must continue to work on our prognostic tools and have honest conversations with patients and their families to formulate individualized treatment plans. This becomes even more important when factors like economic impact of intervention are considered. In an era where cost-effective care has garnered more attention than ever before, we must do our best to make sure our interventions are in line with patient goals and offer the maximum amount of benefit, given the current cost of TAVR.