Transcatheter Aortic Valve Implantation in Centers Without Cardiac Surgery: A Preliminary Medico-Legal Discussion in Italy

Background/Objectives: The expansion of minimally invasive and transcatheter approaches has progressively blurred boundaries between medical and surgical disciplines. Valvular heart diseases, especially aortic ones, exemplify this translational shift, with transcatheter aortic valve implantation (TAVI) increasingly replacing conventional cardiac surgery. Current guidelines recommend the performance of these procedures in centers equipped with on-site cardiac surgery, ensuring management of time-dependent complications. In fact, even if the incidence of major complications is low, the absence of immediate surgical bailout may translate into a concrete loss of therapeutic opportunity.