[Evolution and Future Prospects of Transcatheter Aortic Valve Implantation].

Abstract

With the aging population, the prevalence of aortic stenosis (AS) is increasing, and transcatheter aortic valve implantation (TAVI) has become a promising treatment, particularly for high-risk patients. Over the past decade, TAVI technology has advanced rapidly, and three major devices-SAPIEN (balloon-expandable), Evolut (self-expanding), and Navitor (self-expanding)-are now widely used in Japan. Each device offers unique structural and procedural characteristics: SAPIEN provides precise positioning and strong anti-paravalvular leak features; Evolut offers excellent hemodynamics, especially in small annuli; and Navitor features a flexible delivery system and enhanced sealing via NaviSeal. Long-term data show favorable outcomes for all devices, though each has distinct advantages and limitations. Recent concerns include the management of younger patients and the rise in TAVI explant procedures. Thus, selecting the optimal device based on patient anatomy, risk profile, and future reintervention potential is increasingly emphasized. This review summarizes the key features and clinical outcomes of these devices and discusses future directions toward personalized treatment strategies, including lifetime management approaches. As TAVI expands to lower-risk and younger populations, balancing durability, procedural safety, and reintervention strategies will be essential to ensuring long-term clinical success.