Transcatheter aortic valve implantation for symptomatic severe aortic stenosis and its expanding clinical indications

Abstract

Transcatheter aortic valve implantation (TAVI) is a minimally invasive treatment for symptomatic severe aortic stenosis (AS) that was initially developed for patients with prohibitive surgical risk. Since the first-in-human procedure in 2002, TAVI has gained global acceptance owing to its favorable clinical outcomes and faster recovery than those associated with surgical aortic valve replacement. Landmark trials have demonstrated the noninferiority or superiority of TAVI across high-, intermediate-, and low-surgical risk populations, leading to guideline endorsement as a recommended option for appropriately selected patients across all surgical risk groups. Furthermore, long-term follow-up data support the durability of contemporary TAVI devices. Beyond its current established indications, TAVI is being explored for broader applications such as asymptomatic severe AS, moderate AS with heart failure, and pure aortic regurgitation; however, these uses remain investigational and are not yet part of formal guidelines. This review summarizes TAVI's historical evolution, pivotal clinical trial evidence, and procedural innovations that have enabled its widespread use. We explore Korea-specific experiences with TAVI implementation, highlighting national registry data, healthcare policy considerations, and institutional adoption. Future perspectives include long-term device performance, lifetime valve management strategies, and the integration of artificial intelligence into transcatheter valve therapy.