Transcatheter aortic valve implantation has evolved rapidly since the first successful procedure over 5 years ago. The femoral arterial and the left ventricular apical approaches are currently favored. Initial skepticism has to some degree given way to acceptance that the procedure might be a reasonable alternative for selected patients who might be at high risk with conventional thoracotomy and cardiopulmonary bypass. Uncertainty remains about outcomes, implications, durability, and the appropriate role for this new therapy. It appears likely that transcatheter valve implantation will become a more widely available and accepted therapeutic option.