Transcatheter aortic valve implantation (TAVI) is a truly minimally invasive technique allowing for off-pump aortic valve implantation in selected high-risk patients. Potential advantages are the avoidance of cardiopulmonary bypass, aortic cross-clamping, and sternotomy. Feasibility has been proven for a retrograde transfemoral, retrograde trans-subclavian, and antegrade trans-apical approach. Superiority of one of these delivery routes is as yet unproven. Given the excellent outcome following conventional aortic valve replacement even in octogenarians and the lack of prospectively randomized trials proving the effectiveness of TAVI, this new innovative technique should be restricted to selected high-risk patients at present. Nevertheless, TAVI has already evolved into a routine procedure in selected specialized centers providing a safe and reproducible treatment option for high-risk elderly patients suffering from severe symptomatic aortic stenosis.