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The Society of Thoracic Surgeons (STS) continues to advocate for Medicare coverage policies that support patient safety, multidisciplinary decision-making, appropriate surgical involvement, and evidence-based care as transcatheter aortic valve replacement (TAVR) expands into new patient populations and indications.

Recent efforts have centered on two significant actions by the U.S. Centers for Medicare & Medicaid Services (CMS): the ongoing National Coverage Analysis (NCA) for TAVR for native aortic regurgitation (AR) and the recently finalized National Coverage Determination (NCD) for TAVR for aortic stenosis.

STS Urges Key Safeguards as CMS Considers TAVR Coverage for Aortic Regurgitation

STS has submitted comments to CMS on the NCA for TAVR for patients with native AR, calling for safeguards that preserve cardiac surgeon involvement, multidisciplinary decision-making, and continued evidence development as the therapy enters broader clinical practice.

The effort builds on STS’s extensive advocacy during CMS’s recent review of the national coverage policy for TAVR for aortic stenosis. As part of a joint effort with the American College of Cardiology (ACC) and the Society for Cardiovascular Angiography & Interventions (SCAI), STS has emphasized the importance of in-person surgical evaluation, dual operators, and coverage with evidence development (CED).

STS also has independently emphasized to CMS that surgical involvement should be required, rather than optional, both in evaluating patients with isolated native AR and in performing TAVR for AR.

A Distinct Application of TAVR

TAVR for native AR is a novel and clinically distinct application of transcatheter valve therapy, with significantly less clinical trial data and real-world evidence than TAVR for aortic stenosis.

The difference in experience is substantial. The STS/ACC TVT Registry has recorded nearly 1 million patients undergoing TAVR across 850 U.S. sites since 2011, while the expanded ALIGN-AR study enrolled 700 patients with native AR across 30 U.S. centers through July 2025.

Native AR also presents distinct anatomical and procedural challenges that make appropriate patient selection, multidisciplinary decision-making, and procedural expertise especially important as the therapy enters broader clinical practice.

Safeguards for Evidence-Based TAVR Care

To address these concerns, STS is calling on CMS to include the following requirements in its coverage policy:

• Required in-person evaluation by both specialties: Patients with isolated native AR should be evaluated in person by both an interventional cardiologist and a cardiac surgeon.
• A two-operator model: TAVR for native AR should be performed jointly by an interventional cardiologist and a cardiac surgeon.
• Coverage with evidence development: The limited evidence supporting TAVR for native AR does not yet warrant the same degree of flexibility outlined in the recent TAVR national coverage policy for symptomatic aortic stenosis, and therefore, data for this procedure should be captured under the provisions of CED.

Preserving the Model That Generated the Evidence

The pivotal ALIGN-AR trial used a multidisciplinary heart team that included both interventional cardiology and cardiac surgery to determine surgical risk and treatment eligibility, as well as to perform the procedure.

STS believes Medicare coverage should reflect the framework under which the evidence supporting this indication was generated. Requiring both specialties preserves this multidisciplinary model while experience and real-world evidence continue to accumulate. 

CMS Finalizes Updated NCD for TAVR Following Nine-Month Review

(originally posted on Sept. 11, 2026)

The Centers for Medicare & Medicaid Services (CMS) has issued its updated National Coverage Determination (NCD) for transcatheter aortic valve replacement (TAVR), concluding a nine-month review process that included extensive engagement from The Society of Thoracic Surgeons (STS) and partner organizations representing the multidisciplinary heart team, including the American College of Cardiology (ACC), the Society for Cardiovascular Angiography & Interventions (SCAI), and the American Association for Thoracic Surgery (AATS).

The final NCD follows CMS' June 15, 2026, proposed decision to update the existing TAVR coverage policy. Throughout the review, STS provided extensive feedback and advocated for policies that preserve the multidisciplinary heart team model, maintain appropriate cardiac surgeon involvement in TAVR evaluation and care, and support continued evidence development as TAVR expands into additional patient populations and indications. View a comparison chart of the existing NCD, proposed changes, and final policy.

STS Advocacy Throughout the Process 

STS was actively engaged throughout the NCD review, working both independently and as part of a multi-society coalition. The Society submitted formal comments, met with CMS officials involved in developing the policy, engaged CMS leadership, and participated in discussions with the NCD requester Edwards Lifesciences and other professional societies regarding areas of potential consensus. 

Throughout the process, STS consistently advocated for three priorities:

• Preserving the multidisciplinary heart team model as an essential component of TAVR decision-making.
• Maintaining cardiac surgeon involvement in patient evaluation, treatment decisions, and TAVR care.
• Continuing evidence development in areas where important clinical questions remain unanswered.

STS also advocated for expanded evidence development requirements as TAVR moves into newer indications and lower-risk patient populations, including severe bicuspid aortic stenosis, moderate aortic stenosis, pure aortic regurgitation, valve-in-valve procedures, and patients at low surgical risk. 

From the Existing Policy to the Final NCD 

The original TAVR NCD, established in 2012, helped guide the measured adoption of TAVR in the United States by establishing coverage requirements that included participation by a multidisciplinary heart team and the availability of on-site cardiac surgical services.

CMS reopened the NCD in December 2025 following a request from Edwards Lifesciences. During the subsequent review, STS worked to ensure that an updated policy would recognize advances in TAVR while maintaining safeguards that support patient safety, multidisciplinary decision-making, and evidence-based care.

CMS released its final NCD on September 10, 2026. The NCD maintains requirements for hospitals to have on-site cardiac surgery capabilities and access to critical care resources and continues to recognize the multidisciplinary heart team. CMS removed coverage with evidence development (CED) status for severe symptomatic aortic stenosis (AS). It has approved TAVR for asymptomatic severe aortic stenosis but under the provision of CED.

CMS defined the heart team as at least one cardiologist and one surgeon, but also included advanced practice providers, nurses, and other members. While the suitability for surgical aortic valve replacement must be evaluated, the only mandated in-person visit is the TAVR operator. They state that another evaluation by an additional heart team TAVR operator is not required but is covered if performed. A single TAVR operator is acceptable, and it may be a cardiologist or surgeon. If determined appropriate by the heart team, a second operator would be supported and it may be a cardiologist or a surgeon.

What the Final NCD Means

The final policy maintains several important elements of the existing TAVR coverage framework, including:

• Continued requirements for hospitals to have on-site cardiac surgery capabilities.
• Continued access to critical care resources.
• Recognition of the multidisciplinary heart team.
• Coverage with evidence development for asymptomatic aortic stenosis.

Looking Ahead

STS will continue to monitor implementation of the final NCD and advocate for evidence-based TAVR care, patient safety, outcomes, and policies that support multidisciplinary decision-making, appropriate surgical expertise, and rigorous evidence development. 

Summary: The final NCD maintains key elements of the existing TAVR coverage framework, including hospital requirements for on-site cardiac surgery capabilities and critical care resources, continued recognition of the multidisciplinary heart team, and CED for asymptomatic aortic stenosis. While the policy does not incorporate all of STS' recommendations regarding cardiac surgeon involvement and expanded evidence development, STS will continue working to ensure that patient safety, multidisciplinary care, and high-quality clinical evidence remain central to TAVR treatment and coverage decisions. 

Our work does not end with the CMS announcement. This is an opportunity for every surgeon involved in valve therapies to stay actively engaged in your heart team, make every effort to evaluate all patients being considered for TAVR or SAVR, and apply all available evidence to provide informed decisions that protect patients. STS will continue to advocate for evidence-based policies that support multidisciplinary care, appropriate surgical expertise and the highest-quality care for patients with structural heart disease. 

The Society of Thoracic Surgeons (STS) has just released an updated STS Risk Calculator Mobile App, expanding access to data-driven surgical risk estimates at the point of care. The updated app adds the Ascending Aorta & Aortic Root Surgery Risk Calculator and brings the SAVR After TAVR Risk Calculator, previously available on the STS website, to the mobile app for the first time.

The new tools build on STS's growing portfolio of procedure-specific risk calculators, which use data from the STS National Database to support clinical decision-making and physician-patient conversations about surgical risk. Available for iOS and Android devices, the STS Risk Calculator Mobile App provides surgeons and multidisciplinary care teams with real-time risk estimates at the bedside or on the go.

The Ascending Aorta & Aortic Root Surgery Risk Calculator was developed using data from more than 67,000 adult ascending aorta and aortic root procedures submitted to the STS Adult Cardiac Surgery Database (ACSD) between July 2017 and December 2024. It provides individualized operative risk estimates for four procedural groups: Bentall procedures, ascending aorta replacement plus aortic valve replacement (Wheat Procedures), valve-sparing root replacement, and isolated ascending aorta surgery.

The SAVR After TAVR Risk Calculator provides procedure-specific risk estimates for patients undergoing surgical aortic valve replacement (SAVR) after a previous transcatheter aortic valve replacement (TAVR). The enhanced risk model incorporates a broader range of surgical scenarios, including patients undergoing concomitant procedures such as aortic surgery, coronary artery bypass grafting, or other valve procedures, as well as emergency and salvage operations. Developed using contemporary data from the ACSD, the calculator helps address the distinct risks associated with surgery following TAVR. STS has identified SAVR after prior TAVR as an increasingly important clinical scenario as TAVR use expands, particularly among younger and lower-risk patients.

The updated mobile app provides access to STS risk calculators using the same statistical models available through the Society's online tools. The app is designed to provide convenient, real-time estimates and facilitate physician-patient decision-making using data from the STS National Database.

The addition of these calculators further strengthens STS's commitment to providing clinicians with evidence-based resources that reflect contemporary cardiothoracic surgical practice and support informed decision-making.

Presented Sept. 17–19 in Chicago, the 2026 STS CABG Academy—hosted by the Society of Thoracic Surgeons—delivered an immersive educational experience for cardiothoracic surgeons and team members focused on skills development, practical learning, and collaboration in coronary revascularization.

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Formerly known as the STS Coronary Conference, the program moved beyond traditional lectures to emphasize dynamic, conversation-driven sessions. Expert faculty explored critical topics through operative videos, cinematic surgical footage, live technical analysis, and troubleshooting discussions, creating an interactive environment that encouraged audience participation and shared learning.

The three-day conference featured hands-on workshops, abstract presentations, and sessions covering advanced grafting strategies, minimally invasive and robotic coronary surgery, conduit selection, hybrid revascularization, and the surgical management of concomitant atrial fibrillation and high-risk patients.

One of the highlights of the event was the Anastomosis Challenge, a three-phase competition testing participants’ knowledge, technical skills, and ability to interpret transit-time flow measurements. The challenge culminated with the CABG Academy Finalists Showdown and an awards ceremony recognizing top performances in the competition and poster presentations.

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Experiences like these are central to the STS CABG Academy. Throughout the meeting, attendees gained practical skills, learned directly from experienced surgeons, and built connections with colleagues and faculty that can extend beyond the conference.

Through hands-on learning, close interaction with expert faculty, and innovative educational formats, the program provided participants with practical tools and techniques to enhance coronary surgery practice.

The Society of Thoracic Surgeons co-presented the 2026 Heart Valve Disease Forum (HVDF) with the Korean Society for Thoracic and Cardiovascular Surgery on Sept. 10-11 in Seoul, South Korea, bringing together experts from around the world to explore the latest advances in aortic valve and root surgery.

Centered on the theme "Restoring Harmony in Aortic Valve & Root Surgery," the forum offered insights into the anatomy, physiology, causes, diagnosis, treatment, and future directions of valvular heart disease.

The meeting attracted 333 participants from 15 countries and featured lectures, case-based discussions, wet labs, and abstract presentations. Key topics included minimally invasive and robotic heart valve surgery, valve-sparing root replacement, aortic root enlargement, and the surgical management of failed transcatheter aortic valve replacement.

“Exceptional presentations, live surgery, and truly engaging discussion translated innovation into impact for patients across Asia and beyond,” said STS President Vinay Badhwar, MD.

A highlight of the forum was a live surgical case involving annular enlargement. The patient had severe symptomatic aortic stenosis and a small aortic root and underwent aortic valve replacement with a bioprosthetic valve and posterior aortic root enlargement using the Yang procedure.

The operation was performed by Seung Hyun Lee, MD, chief of cardiothoracic surgery at Severance Hospital and Yonsei University, and Bo Yang, MD, of the University of Michigan. Dr. Badhwar moderated the case from the audience, while S. Christopher Malaisirie, MD, of Northwestern Medicine, moderated it from the operating room.

Conducted in accordance with the new live surgery policy, the case received positive feedback from attendees and marked the first successful live operative demonstration performed under the policy. Most importantly, the patient experienced no reported complications.

The successful case represented an important step in advancing international surgical education while maintaining the standards and safeguards established for live operative demonstrations.

Through partnerships and programs such as the Heart Valve Disease Forum, STS continues to foster global collaboration, knowledge sharing, and innovation in cardiothoracic surgery.
 

The Society of Thoracic Surgeons participated in its first-ever meeting in Africa as a co-organizer of the inaugural EACTS/STS/CSIA Cardio-Thoracic Conference, held Sept. 4-6 at the University of Cape Town Academic Conference Centre in Cape Town, South Africa. 

Organized by the European Association for Cardio-Thoracic Surgery (EACTS), The Society of Thoracic Surgeons (STS), and the Cardiac Surgery Intersociety Alliance (CSIA), in association with the Society of Cardiothoracic Surgeons of South Africa, the conference brought together cardiothoracic surgeons, health care leaders, trainees, and other professionals from across Africa and around the world. Held under the theme "In Africa for Africa," the meeting focused on advancing clinical education while strengthening cardiothoracic care across the continent.

The three-day program featured presentations, panel discussions, and hands-on simulation covering coronary, aortic, valvular, thoracic, congenital, and pediatric surgery. Sessions also addressed perioperative care, quality improvement, clinical databases and registries, and strategies to strengthen cardiothoracic programs across Africa through workforce development, training, and infrastructure.

Participants explored approaches to sustainable program development and institutional partnerships, reflecting the CSIA mission of expanding access to cardiac surgery through collaboration and capacity building. An international faculty from Africa, North America, Europe, Asia, Australia, and South America fostered knowledge exchange and new opportunities for collaboration.

Organizers envision the conference as the first in a series of events across Africa aimed at advancing education, partnership, and cardiothoracic care throughout the region. The meeting marked an important milestone in STS's efforts to support international collaboration and sustainable growth in cardiothoracic surgery worldwide.

For Sean Jordan, MD, the need was clear: Too many patients across East Tennessee faced significant barriers to lung cancer screening—not because they lacked the need for screening, but because they lacked access to it.

East Tennessee has some of the highest smoking and lung cancer rates in the country, while screening rates remain below national averages. For patients in rural Appalachian communities, mountain roads, long travel distances, limited specialty care, and a lack of CT scanners in many counties can make screening especially difficult.

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Jordan, chief of thoracic surgery and director of lung cancer screening at the University of Tennessee Medical Center (UTMC), saw an opportunity to bring screening directly to the communities that needed it most.

The result is a 45-foot mobile CT lung cancer screening unit designed to serve patients across 21 counties in East Tennessee.

“We needed something that could navigate our geography and be convenient and inviting for patients,” Jordan said.

Making the Mobile Unit a Reality

Bringing the vision to reality required more than clinical expertise. It required funding, collaboration, persistence, and advocacy.

The University of Tennessee Medical Center already had a robust lung cancer screening program, but funding a mobile program presented a significant challenge. Working with Congressman Tim Burchett, the team secured $2.3 million through the U.S. Department of Agriculture to fund the mobile unit and supporting software.

The team then pursued a competitive Rural Health Resiliency grant through the Tennessee Department of Health to support program personnel. STS Advocacy strengthened the application by providing a letter of support from then-STS President Dr. Jenna Romano.

The effort ultimately resulted in a $5.45 million grant—one of the largest awarded in the state—to support personnel for the mobile lung cancer screening program and a mobile mammography program.

Jordan also credits Rob Headrick, MD, chief of thoracic surgery at CommonSpirit-Memorial Hospital-Rees Skillern Cancer Institute-Chattanooga and chair of the STS Workforce on Health Policy, Reform, and Advocacy, with providing guidance and connecting the team with STS Advocacy resources.

Bringing Screening to Patients

The mobile unit will bring CT screening and a multidisciplinary team—including technologists, nurses, patient liaisons, and behavioral health professionals—directly into underserved communities.

“Many patients are not willing to travel outside their communities to seek even basic care,” Jordan said. “We can bring our medical expertise and the CT scanner itself directly to their communities.”

The program will also provide tobacco cessation services, education, and centralized coordination to help patients who need additional care move through the health care system more quickly.

Ultimately, success will be measured by whether more cases of lung cancer are detected at an earlier, more treatable stage.

A medical oncologist once told him that fewer patients seemed to be arriving with stage II and III lung cancer. “That to me is the biggest win I can think of for this community,” Jordan said. “We are shifting the stage of lung cancer earlier to when it is most survivable.”

Leading Through Advocacy

The project took two years to move from funding to implementation, but Jordan hopes its impact extends beyond East Tennessee.

“Reaching out to other mobile lung programs and STS Advocacy can introduce you to a community of like-minded groups” who can share their experiences and help develop programs that work for individual communities, he said.

The experience reinforced Jordan's belief that thoracic surgeons should play a leading role in strengthening screening programs nationwide.

“Apart from patients and families, no one in the hospital sees the benefits of a robust lung cancer screening program as much as thoracic surgeons,” he said. “We should be leaders and advocates for strengthening our own programs and all programs nationwide.”

Now available in audio.