Contemporary Transcatheter Aortic Valve implantation (TAVI) Practice in Europe: Insights from the Second European TAVI Pathway Registry

Abstract Aims Transcatheter aortic valve implantation (TAVI) continues to expand rapidly, with over 100,000 procedures now performed annually in Europe. This growth highlights the need to optimise patient selection and procedural workflows to ensure quality and cost-effective care. The Second European TAVI Pathway Study aimed to describe current TAVI practices across Europe and assess changes since the 2022 edition. Methods Between January and May 2025, TAVI operators from 42 European countries were invited to complete an online survey concerning their centre’s current practice. Results Responses were received from 202 centres in 37 different countries, performing 44,089 TAVI procedures in 2024 (mean 218 per centre; IQR 99–284). Dedicated Heart Valve Clinics are present in 54%, and supportive staff in 52%. Most centres (81%) use a Heart Team approach, with age thresholds for TAVI typically set at ≥75 (64%) or ≥80 (26%) years. On-site cardiac surgery is available in 96% of participating centres. Local anaesthesia alone (33%) or with conscious sedation (63%) are most common for routine transfemoral TAVI. Secondary radial access (70%) and left ventricular wire pacing (59%) have increased from 48% and 43% in 2022, respectively. Early mobilisation (≤8 hours) is routine in 63% of cases, and early discharge (≤2 days) rose from 43% in 2022 to 51% in 2024. However, the proportion of centres reporting waiting times 3 months increased from 19% to 26%. Conclusion Minimalist TAVI approaches are widely adopted across Europe, with increasing rates of early discharge. However, extended waiting times remain a significant challenge.