Post-treatment risks of transcatheter aortic valve implantation: should we be increasing preventative measures?

INTRODUCTION: Transcatheter aortic valve implantation (TAVI) has become an established treatment for severe aortic stenosis across an expanding risk spectrum. As indications extend to younger and lower-risk patients, post-treatment complications with implications for survival, quality of life, and valve durability require attention. AREAS COVERED: This narrative review discusses major post-TAVI complications with direct implications for procedural planning and lifetime management, including cerebrovascular events, conduction abnormalities, coronary obstruction and aortic root injury, bioprosthetic valve dysfunction, valve thrombosis, residual regurgitation, and TAVI-associated infective endocarditis. Evidence was reviewed from pivotal randomized trials, contemporary registries, consensus documents, systematic reviews, and mechanistic studies addressing incidence, pathophysiology, predictors, prognosis, prevention, diagnosis, and management of these complications. EXPERT OPINION: Post-TAVI risk reduction should move beyond reactive complication management toward individualized prevention. Meticulous computed tomography-based planning, optimized valve selection and implantation technique, rational antithrombotic therapy, structured rhythm and valve surveillance, selective use of cerebral embolic protection, timely correction of clinically or hemodynamically significant residual regurgitation, and infection-prevention pathways are central components of contemporary care. Future progress will depend on better risk stratification, longer-term durability data, and targeted preventive strategies adapted to lower-risk patients with longer life expectancy.