Patient selection for TAVI in 2016: should we break through the low-risk barrier?

The earliest evidence supporting transcatheter aortic valve implantation (TAVI) was derived from its comparison with conservative therapy in inoperable patients and with surgical aortic valve replacement (SAVR) in extremely high risk patients. TAVI had a relative advantage in these situations being less invasive and hence less prone to the classic early postoperative devastating complications. To prove as effective in less fragile and less morbid patients, the long-term durability of the haemodynamic and clinical gains from TAVI needs to be confirmed. In this report we will discuss three aspects of the dilemma of expanding TAVI indications to lower-risk patients: first, available data on early and late outcomes after TAVI; second, durability issues; and third, TAVI complications and procedural refinements.