Remaining pitfalls and limitations of TAVI in 2014.

Transcatheter aortic valve implantation (TAVI) has become a feasible and effective therapeutic option for patients with severe aortic stenosis and high operative risk or relative contraindications for surgical aortic valve replacement (SAVR). However, as with every new technology, a number of potential pitfalls and limitations have to be addressed and future opportunities have to be clarified in well-conducted clinical trials and well-monitored registries. Procedural issues are still controversial, and technical and procedural enhancements are required to reduce complications. Moreover, further studies are essential to evaluate second-generation devices in a broader patient population in order to understand whether the theoretical benefits of improved valve designs translate into fewer complications and a better long-term survival. Adjunctive devices, such as cerebrovascular protection devices, have to be further evaluated in clinical trials. This manuscript will focus on current procedural and post-procedural limitations of TAVI and future opportunities to overcome those challenges.