Transcatheter aortic valve implantation in 2026.

Since the first implant over two decades ago, transcatheter aortic valve implantation (TAVI) has become the standard treatment for patients with severe aortic stenosis at high and intermediate risk, with mounting evidence to support its use in the younger lower-risk patient. Increasing operator experience and ongoing technological advances have both refined the procedure and reduced overall risk. However, important challenges remain, including coronary access after TAVI, conduction disturbance following implantation, the long-term consequences of paravalvular leak, cost-effectiveness and broader implications on healthcare systems. This review is timely following publication of the latest European Society of Cardiology guidelines on the management of valvular heart disease and recent landmark trials. We aim to provide an update on key areas of development including patient selection, imaging, management of coronary disease, valve durability and lifetime management.