Editor’s Pick: State of the Art of Aortic Valve Implantation: Indications, Outcomes, and Controversies

Abstract

During the last decade, transcatheter aortic valve implantation (TAVI) has become a revolution in the treatment of high-risk severe aortic stenosis (AS). Current guidelines provide a Class I indication for TAVI in inoperable AS and Class IIa indication for TAVI as an alternative to surgical repair in high-risk patients. A large amount of retrospective, prospective, and randomised data has been published covering almost every angle of the procedure. Improved patient evaluation and selection, new devices, and technical refinements will reduce procedural complications and improve long-term outcomes. With a growing elderly population segment in the Western countries, the procedure has a bright perspective. The purpose of this review is to summarise the state of the art of TAVI procedures, including current indications, and describe procedural characteristics, as well as short and long-term outcomes. Controversial issues such as paravalvular regurgitation and stroke are discussed, as well as off-label indications. A shift towards intermediate risk AS patients, approval of some of the off-label indications, and device versus device competition are some of the future directions of the technique.