Where should transcatheter aortic valve implantation go beyond 2012?

Although surgical aortic valve replacement (sAVR) remains the gold standard treatment for severe, symptomatic aortic stenosis in a low-risk population, the role of transcatheter aortic valve implantation (TAVI) has increased significantly in the past decade and has entered the 'clinical mainstream' for the treatment of high-risk, inoperable patients. The transcatheter technique has evolved and improved immeasurably since its introduction some years ago. Not only is valve design evolving, but access site, size/technology of delivery systems and procedural technique are also undergoing continuous refinement. New devices are now available to prevent complications such as cerebral embolization, and occlusion balloons and covered stents are used to manage vascular complications more expertly. Early experiences are being gained in the treatment of failing bioprostheses - so-called 'valve-in-valve' therapy, even in the mitral position. In this article, we discuss the new transcatheter alternatives to open heart valve surgery and review the most recent clinical evidence and the currently available and emerging technology in transcatheter treatment.