Evaluating the Accessibility of Transcatheter and Surgical Aortic Valve Replacement Across the US Via Driving-Times

While transcatheter aortic valve replacement (TAVR) is a rapidly expanding minimally invasive alternative to surgical aortic valve replacement (SAVR), its access might be limited due to proximity to a TAVR center. Among Medicare beneficiaries, real-world driving times from residential zip codes to TAVR and SAVR center zip codes were computed using the Google Distance Matrix Application Programming Interface. Zip code-level sociodemographic correlates of driving times more than 1 hour to TAVR and SAVR centers were computed using generalized linear mixed-effects models. Of 29,089 US residential zip codes, 407 (1.4%) had a TAVR center and 639 (2.2%) a SAVR center. The median driving time to the nearest zip code with a TAVR center (59 min [IQR, 30-96]) was longer compared with SAVR center (44 min [IQR, 24-73]), and driving times were longer in Western and Southern regions compared with the Northeast. A higher proportion of beneficiaries drive over 1 hour to nearest TAVR center (24.3%) compared with SAVR center (13.1%). Zip codes with a higher median age, a higher ratio of Hispanic to White individuals, and outside metropolitan areas were more likely to have driving times longer than 1 hour to the nearest TAVR centers. In conclusion, access to TAVR is consistently lower compared with SAVR centers, particularly in the Western and Southern US. The geographic barrier to access care, particularly among socioeconomically disadvantaged rural communities, requires evaluating the selection process for sites that provide care.