State of Art of Transcatheter Aortic Valve Implantation for the Treatment of Aortic Stenosis in Low-Risk Patients: A Perspective on Brazilian Contributions and Implementation Challenges.

Transcatheter aortic valve implantation (TAVI) has profoundly changed the management of severe aortic stenosis (AS), evolving from a treatment reserved for inoperable and high-risk patients to an established therapeutic option across a wide surgical risk spectrum. Although the expansion of TAVI indications has been largely supported by randomized clinical trials conducted in high-income countries, real-world experience and technological contributions from distinct healthcare systems are increasingly relevant. Brazil has played a significant role in the early adoption, structured implementation, and clinical evaluation of TAVI in Latin America. Since the first procedures performed in 2008, Brazilian centers have developed Heart Team models, contributed to national and regional registries, and generated real-world evidence demonstrating procedural safety and effectiveness comparable to international benchmarks, despite the presence of resource limitations and a higher prevalence of complex clinical and anatomical scenarios. The incorporation of TAVI into the Brazilian public health system in 2022 marked a major milestone in expanding access to minimally invasive therapy for patients with severe AS. In parallel, Brazilian scientific societies have adapted international guideline recommendations to local practice, supporting evidence-based patient selection across different surgical risk categories. Notably, Brazil has also emerged as a developer of locally engineered transcatheter valve technologies, highlighting its transition from a technology consumer to an active contributor in the field of structural heart disease. This review summarizes the historical evolution, national experience, clinical outcomes, guideline integration, technological innovation, and health economic considerations of TAVI in Brazil.