TRANSCATHETER THERAPY IN AORTIC STENOSIS: EVOLUTION OF TAVI AND FUTURE PERSPECTIVES

Abstract

Objective: To review the historical evolution, main indications, and complications associated with transcatheter aortic valve implantation (TAVI), as well as to discuss future perspectives in cardiology practice. Literature review: Aortic stenosis is the most prevalent valvular disease in the elderly, associated with high morbidity and mortality when left untreated. For decades, surgical aortic valve replacement (SAVR) was considered the standard therapy but presented significant limitations in frail or high-risk patients. The introduction of TAVI in 2002 revolutionized disease management, initially restricted to inoperable or high-risk cases and progressively expanded to intermediate- and, in selected contexts, low-risk patients. Multicenter clinical trials have demonstrated equivalence, and in some outcomes even superiority, compared with SAVR. Despite technological advances and increasing operator experience, challenges remain, such as paravalvular regurgitation, need for permanent pacemaker, vascular complications, and uncertainty regarding prosthesis durability in younger patients and those with bicuspid valves. Final considerations: TAVI has been consolidated as a major therapeutic strategy in the treatment of aortic stenosis, with a clear trend toward further expansion. Individualized decision-making between TAVI and SAVR, supported by the development of new devices and long-term studies, is essential to optimize clinical outcomes and prognosis.