TAVI in Patients Unsuitable for Surgery

Since Alain Cribier performed the first human transcatheter aortic valve implantation (TAVI) in 2002 (1), the procedure has evolved into a reproducible and safe technique with >100,000 procedures performed worldwide. Early experience with new devices and techniques in Europe led to advanced procedural techniques, and large commercial and national registries provided real-world outcome data (2–4). Nevertheless, despite excellent results, various studies also demonstrated that although TAVI is a promising alternative treatment option for patients at high risk for surgical aortic valve replacement (SAVR), there is a group of patients who, despite successful prosthetic valve implantation, do not benefit from the procedure. It became clear that for the benefit of these patients, as well as to improve the economic strength and future viability of TAVI, treatment of this futile cohort should be avoided. Therefore, major attempts have been made to develop a clear understanding of the characteristics of this patient group; so far, there has not been much success.