Transcatheter aortic valve implantation (TAVI) is evolving, with a dramatic increase in the number of procedures all over the world and a progressive shift to lower-risk patients. Valvular heart centres are accordingly adapting to the new needs and targets of the treated population. The purpose of this review is to provide an overview of the evolution of heart valve centres following changes in TAVI over time. In particular, we will discuss: 1) new challenges for the Heart Team in patient profiling and procedural tailoring; 2) the continued need for TAVI to be performed in high-volume centres with cardiac surgery on site; and 3) the importance of integrated imaging tools in modern heart valve centres.