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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. 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