TAVI—Evolution in Landscape

This article is part of CTSNet’s Guest Editor Series, 21 Years After First TAVI: Will Pace of Innovations Continue for All Heart Valves? Guest editor Gry Dahle has curated a robust collection of content that shares the knowledge, techniques, and insights of several distinguished experts from around the world. 

Since the first transcatheter aortic valve replacement (TAVR) was performed twenty years ago in April 2002, TAVR has become the preferred therapy for symptomatic severe aortic stenosis over surgery. Several significant advances have made TAVR safer, more reproducible, and effective. These include advances in technology, preprocedural planning, procedural technique, and postprocedural management. Clinical evidence and education in TAVR have also made remarkable strides with multiple randomized trials and registries, educational apps, and courses to train heart teams on evaluating patients for and performing TAVR. 

However, there remain several limitations of TAVR, including stroke, paravalvular leak, permanent pacemaker implantation, coronary access, and future reintervention. In younger patients with longer life expectancies, the decision between TAVR and surgery as the first aortic valve intervention should be made on an individual basis with patient-centered care in mind. 

Future directions include both basic science and clinical research on the upstream and downstream effects of TAVR and continuing improvements to facilitate the lifetime management of patients with aortic valve disease.