A Glimpse into the Future: In 2020, Which Patients will Undergo TAVI or SAVR?

Transcatheter aortic valve implantation (TAVI) has evolved into a safe and effective procedure to treat symptomatic patients with severe aortic stenosis (AS), with predictable and reproducible results. Rates of important complications such as vascular complications, strokes and paravalvular leaks are lower than ever, because of improved patient selection, systematic use of multidector computer tomography, increasing operator experience and device iteration. Accumulating data suggest that transfemoral TAVI with newer generation transcatheter heart valves and delivery systems is superior to conventional surgical aortic valve replacement among intermediate- and high-risk patients with severe symptomatic AS with regard to all-cause mortality and stroke. One can anticipate that by 2020, the majority of patients with severe symptomatic AS will undergo TAVI as first line therapy, regardless of surgical risk.