Even as the U.S. Centers for Medicare & Medicaid Services (CMS) grapples with the question of volume requirements for centers performing surgical and transcatheter aortic valve replacements (AVRs), a new study suggests that surgical AVR volumes in the U.S. fell sharply between 2011 and 2014. The data are almost certain to understate the current state of affairs – a fact that could complicate the CMS's efforts to sustain its current SAVR volume requirements in the TAVR national coverage memo.