Perspective:

This systemic review summarizes the current state of TAVI and suggests that TAVI has come of age and become a routine strategy for aortic valve replacement, increasingly performed under conscious sedation via transfemoral access. Simplification of the technique, accumulation of clinical experience, and improvements in valve design and delivery systems have led to a dramatic reduction in complication rates. These advances have allowed transition to lower-risk populations, and outcome data from the PARTNER 2A and SURTAVI trials have established a clear evidence base for use in intermediate-risk patients. Currently, ongoing studies with an expanding portfolio of devices seem destined to further expand indications for TAVI towards lower-risk, younger, and asymptomatic populations.

Some challenges do remain, and TAVI must demonstrate long-term durability equivalent to surgical bioprostheses, and strategies are needed for dealing with structural valve deterioration when it occurs. We also need to reduce the requirement for permanent pacemaker implantation and ensure minimal incidence of paravalvular leak before TAVI can be widely used in younger patients. Overall, TAVI appears poised to be the preferred strategy for aortic valve replacement in most patients in a few years.