**3. Transcatheter treatment for aortic valve disease**

For the treatment of severe symptomatic aortic stenosis, surgical aortic valve replacement has been the gold standard. The advent and rapidly widespread adoption of transcatheter aortic valve replacement (TAVR) has now resulted in it becoming the option for patients who would have been considered inoperable or prohibitively high surgical risk [32]. Excellent mid-term and long-term outcomes after TAVR have been reported [33, 34], and indications of TAVR are expanding to severe aortic valve regurgitation associated with moderate aortic valve stenosis and valve-in-valve procedures for surgical bioprosthetic valve failure.

TAVR procedures are now shifting to percutaneous approach and even general anesthesia is not mandatory. The percutaneous transfemoral route is the preferred approach in the majority of the cases due to its associated advantages [35]. Although some centers reported that transapical and transfemoral approach resulted in the similar outcomes [36], transapical approach is usually associated with poorer outcomes than transfemoral approach [37]. Interventional cardiologists possess the required skills for transfemoral TAVR including the handling of guidewires, catheters, and image selection. They can even take care of technical complications associated with TAVR, such as coronary obstruction and conduction disturbance by performing PCI or implanting pacemaker. Although interventional cardiologists can take a lead in TAVR procedures, surgeons still play an important role in managing life-threatening complications such as aortic root rupture, cardiac tamponade, and vascular complications. Those complications cannot be managed percutaneously and surgical interventions are the only viable rescue option. Furthermore, surgeons have the skill to ensure procedural success in patients whom transfemoral approach is not applicable. For the success of transapical and transaortic TAVR procedures, surgeons play a crucial role and they should be familiar with individual cases and technical aspects.

Postprocedural care and rehabilitation are undoubtedly important in optimizing functional status and clinical outcomes [38]. Cardiologists can take the leading role in this area by virtue of familiarity with all aspects of general cardiology issues such as heart failure and arrhythmia in the management of these complex patients.

In conclusion, a good collaboration between interventional cardiologists and cardiac surgeons and formulation of a Heart Team is essential for the success of TAVR. The decision making for patients selection and surgical approach, the actual performance of procedure in the operating room, and postoperative care should be performed by a Heart Team approach [39].
