The American College of Cardiology recently certified all the established transcatheter valve (TV) programs at Houston Methodist, one of only two U.S. health care systems to have four of its hospitals meet the association's standard of excellence.

Houston Methodist Hospital, Houston Methodist Sugar Land Hospital, Houston Methodist The Woodlands Hospital and Houston Methodist West Hospital in December received the accreditation for their TV programs, which focus on transcatheter aortic valve implantation (TAVI). TAVI has revolutionized heart care in the last decade.

"This is an external validation of our expertise, dedication, team composition and commitment to team learning," says Dr. Stephen Little, a cardiologist at Houston Methodist who led the certification effort. "Because of it, we are able to export our expertise in a structured, reproducible way to our community hospitals. It speaks to the notion that the Houston Methodist DeBakey Heart & Vascular Center is not restricted to the Texas Medical Center."

Houston Methodist has long been a leader in TAVI research, enrolling large volumes of patients in the earliest trials investigating the procedure as far back as 13 years ago. In the years since, it has performed among the most TAVI procedures in the nation.

Houston Methodist Hospital and Mount Sinai Hospital are the only U.S. News & World Report 2022 Honor Roll hospitals with transcatheter valve programs certified by the American College of Cardiology (ACC). Mount Sinai's certification is only for its Manhattan hospital.

One of cardiology's great advances

The ACC began certifying hospitals for their transcatheter valve programs in 2019, after TAVI's popularity exploded. Participation is voluntary.

Transcatheter aortic valve implantation is considered one of the most significant advances in cardiology since the 1960s, saving thousands of lives a year and shortening patient recovery time from months to days.

Houston Methodist doctors annually perform about 350 TAVI procedures at Houston Methodist Hospital, the system's flagship hospital in the Texas Medical Center in Houston. In addition, they perform more than150 TAVI procedures annually at other hospitals in the system. In all, doctors throughout Houston Methodist have performed more than 3,000 of the procedures.

TAVI treats patients with aortic stenosis, a condition, caused by an accumulation of calcium, that narrows the aortic valve and makes it more difficult for the blood to leave the heart and travel to the rest of the body. Former First Lady Barbara Bush drew attention to the condition nearly 15 years ago when she was treated for aortic stenosis at Houston Methodist.

The condition, fatal if not treated, historically required open-heart surgery, which involves opening the chest and stopping the heart to insert an artificial valve. With TAVI, access to the heart is gained through a leg artery, thus avoiding the need for surgical recovery.

(Related: TAVI Shows Durable Benefits in Three-Year, Low-Risk Clinical Trial)

The procedure was approved first for patients too sick and frail for open-heart surgery, then for patients at intermediate risk and, more recently, for low surgical-risk patients.

In that time, transcatheter aortic valve implantation has become patients' most requested aortic valve repair intervention. The number of procedures has increased every year since initial FDA approval for inoperable or extreme risk patients in 2011, and began exceeding all forms of surgical aortic valve replacement for the first time in 2019, following FDA approval for low-risk patients.

The ACC instituted the Transcatheter Valve Certification as an external review process to guide hospitals' efforts to meet standards of:

• Excellence for multidisciplinary teams
• Formalized training
• Shared decision-making
• Registry performance.

It does not audit outcomes but requires that hospitals participate in an established national clinical database, such as the Society of Thoracic Surgeon/American College of Cardiology Transcatheter Valve Therapy Registry.

The ACC's TV certification also includes mitral valve transcatheter edge-to-edge repair procedures, also known as TEER.

Dr. Little says that upon learning of the certification last year, Houston Methodist decided to invite ACC officials to audit the system's process to validate what it was already doing and discover if there were areas for improvement.

Each ACC certification follows a review conducted independently of other hospital sites. The ACC certified Houston Methodist's TV program first, and the system's other three certifications followed within three weeks.

Systemization of TAVI represents new territory

Dr. Little says the team took particular pride in the fact that the lead ACC auditor told members she had not seen a site so well positioned for immediate TV accreditation.

"It's great to have this corroboration that we've got all our ducks in a row," says Dr. Little, director of Houston Methodist's Structural Heart program. "Unlike some other centers, we've created a robust infrastructure that's highly organized and structured and able to export expertise. We're happy the ACC agreed that it's a good model for the entire system."

The notion of a systematization of service lines is relatively new territory, says Dr. Little. He said within cardiology this is one of the early efforts providing such therapy systematization at multiple hospitals.

In the aftermath of the certification, Houston Methodist Willowbrook Hospital launched a TV program this year. The plan is to pursue certification for it later in 2023.

There are currently 92 hospitals on the ACC's TV Certification list, seven of which are in Texas.