Transcatheter aortic valve implantation (TAVI) can now be considered for any patient with symptomatic severe aortic stenosis (AS) who is set to receive an aortic valve replacement with a bioprosthesis1-4. In particular, the recent low-risk trials may dramatically increase the pool of eligible TAVI candidates, with estimates as high as 270,000 patients in Europe and North America5 . The healthcare challenges for heart valve centres are significant. Different levels within a given TAVI programme require restructuring to cope with this changing supply/demand reality at reasonable cost and without concessions in quality. This includes: 1) stronger ties with referral hospitals to relocate preprocedural TAVI work-up outside of the implanting heart valve centres; 2) implementation of local anaesthesia/mild sedation protocols to minimise catheterisation laboratory occupation time; 3) avoidance of unnecessary time spent in intensive care units and general cardiology/cardiac surgery wards, and 4) harmonising institutional logistics