[TAVI in Non-Surgical Centers: Balancing Clinical Pragmatism and Regulatory Challenges]

TAVI has emerged as a safe and effective alternative to surgical aortic valve replacement, including in low-risk patients. However, French regulations still require the procedure to be performed exclusively in centers with on-site cardiac surgery. While historically justified, this requirement now appears outdated in light of technical advancements, reduced complication rates, and reassuring registry data. Several countries have already demonstrated the feasibility and safety of TAVI in experienced non-surgical centers. The current restriction generates inequalities in access, longer waiting times, and loss of patient opportunity. A structured evolution of the model, based on experience, quality criteria, and organized collaborations, could broaden access to TAVI without compromising safety. It is time to reconcile safety, pragmatism, and equitable access.