Transcatheter aortic valve implantation: Contemporary evidence, patient selection, and procedural strategies

Objective: Transcatheter aortic valve implantation (TAVI) has transformed the management of severe aortic stenosis (AS), evolving from a therapy for high risk patients into a widely adopted intervention across diverse clinical settings.This study aimed to summarize contemporary evidence on TAVI, with a focus on patient selection, procedural planning, and clinical outcomes.Methods: This narrative review was conducted through a structured literature search of PubMed and Scopus, for studies published between 2016-2025, including randomized controlled trials, observational registries, and current guideline documents on TAVI.The target population included patients with severe AS undergoing TAVI.Key variables included patient characteristics, anatomical suitability, imaging based planning, procedural strategies, and clinical outcomes.Data were qualitatively synthesized using a descriptive approach to evaluate current evidence and identify knowledge gaps.Results: TAVI demonstrated comparable clinical outcomes to surgical aortic valve replacement, with sustained hemodynamic performance and favorable mid-to long-term durability.Optimal patient selection has shifted toward a comprehensive evaluation incorporating age, life expectancy, anatomical considerations, and comorbidities.Advances in multimodality imaging, particularly computed tomography, improved procedural planning and device selection, contributed to high procedural success and reduced complication rates.Simplified procedural strategies were associated with lower vascular complications and conduction disturbances.TAVI was feasible in selected complex anatomies, including bicuspid valves and valve-in-valve procedures, although challenges remained in pure aortic regurgitation.Despite these advances, uncertainties persisted regarding long-term durability, management of concomitant coronary artery disease, and predictors of adverse outcomes.Conclusion: TAVI is an effective and evolving therapy for severe AS, providing outcomes comparable to surgical intervention when appropriate patient selection and procedural planning are applied.Further evidence is required to optimize long-term durability and management strategies in complex patient populations.