Rick A. Nishimura et al. JACC 2019;73:2609-2635 Categorization of Sites Based on TAVR Volume and Risk-Adjusted Mortality This schematic categorizes TAVR programs by their case volumes and risk-adjusted clinical outcomes. Most programs have sufficient case volumes to achieve technical competence and acceptable results, although these volumes may not be sufficient to allow statistically valid quality assessments. A few programs may have adequate volumes to meet TAVR requirements and ensure statistically valid quality assessment but still appear to have suboptimal performance. These programs need to take immediate actions to improve their outcomes as it is likely they are underperforming. Some programs with lower volumes appear to have acceptable outcomes, but because of their small sample sizes, their outcome data are less statistically reliable. These programs must continue to assess their quality vigilantly. Finally, some programs have low volume and less than optimal outcomes. Although these outcomes are statistically less certain, action should be undertaken immediately to further assess and improve quality (26). TAVR indicates transcatheter aortic valve replacement. Rick A. Nishimura et al. JACC 2019;73:2609-2635 2019 American Association for Thoracic Surgery, the American College of Cardiology Foundation, the American Society of Echocardiography, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons