devices from 10% (first generation) to 8.3% (second generation) to 0% (third generation). Overall 30-day mortality for the three generations was 40%, 8.3% and 10.8%, respectively. Pooled data demonstrated a significant improvement in mean NYHA functional class (from 3.3 to 1.7, p < 0.001), without a difference between the three generations. Importantly, NYHA functional class and mean pressure gradient remained stable up to 12 months follow-up in all three generations. In addition, the results of a multicentre registry with the third generation CoreValve ReValving system have recently been reported. A total of 646 patients from 51 centres were included in the registry. It was a high-risk elderly population (mean age 81 years) with a poor functional class (85% of the patients in NYHA class III or IV), and a high logistic EuroSCORE (mean 23.1%). Procedural success was achieved in 628 of the 646 patients (97.2%). All-cause 30-day mortality was 8%, and the combined end point of procedural related death, stroke or myocardial infarction was reached in 60 patients (9.3%). After successful implantation, mean pressure gradient decreased from 49 mmHg to 3 mmHg [18]. Conclusions Percutaneous aortic valve implantation was developed in order to provide an alternative and less invasive method of treating aortic valve stenosis. It has now been proven that the method is feasible, with results that have been reproduced by many physicians in many centres (approximately 8000 implantations to date). Today there are at least 10 new percutaneous aortic valves that have had their first implantation in humans, many more that have reached the level of animal experiments, and even more that are still in the initial design stage. As a new treatment tool it has to be evaluated in randomised controlled trials with long- term follow-up in order to assess the safety and efficacy. Therefore, the performance of PAVI should be restricted to a limited number of high-volume centres, which have both cardiology and cardiac surgery departments, with expertise in structural heart disease intervention and high-risk valvular surgery. Due to the excellent results with surgical valve replacement, patient selection, which should be performed in multidisciplinary conferences, is of utmost importance. Like other interventional procedures, there is a learning curve with significant improvements in the success rate and the clinical results after the first 25 procedures, which implies that the PAVI procedure should be initially performed and thereafter supervised by a special team [19, 20]. Beside the selection and intervention of PAVI, close follow-up with assessment of clinical and objective parameters is mandatory for defining the indications of this technique. Percutaneous aortic valve implantation R e f e r e n c e s 1. Nkomo VT, Gardin JM, Skelton TN, et al. 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