Professor Ole de Backer has performed thousands of TAVI procedures. At Rigshospitalet in Copenhagen, where the team expects to surpass 650 TAVI procedures in 2026, he works in a structural heart field shaped by constant clinical and technological development. Yet experience has not made every case routine.
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“Every patient has a specific anatomy and can have specific challenges.”
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For Ole, experience strengthens the ability to anticipate risk, prepare for different scenarios and make informed decisions around the individual patient. However, even after thousands of procedures, there is always more to learn.
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DRAWN TO THE IMMEDIATE IMPACT OF INTERVENTIONAL CARDIOLOGY

Ole completed his medical education in Belgium and worked across several disciplines during his clinical training. Cardiology stood out because of the direct effect treatment had on the patient.
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“You really have an immediate and direct impact on the patient’s life.”

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Seeking additional training in advanced interventional cardiology, Ole moved to Copenhagen for a fellowship in 2011. The field of Structural Heart Interventional Cardiology was already more developed and established in Northern Europe in that time. What began as additional training became a permanent move.

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“There was so much going on and the program was growing, a lot of new innovations coming, so that kept me there.”

Fifteen years later, this pace of development remains one of the aspects of structural heart intervention he finds most compelling.

HIGH VOLUME CHANGES THE ENTIRE PATIENT PATHWAY

‍Rigshospitalet expects to surpass 650 TAVI procedures in 2026.
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At this volume, Ole describes the challenge as much broader than performing the intervention itself. The entire pathway needs to support an efficient and safe patient flow before, during and after the procedure. Ten years ago, the team routinely treated two TAVI patients a day using general anesthesia and a more complex setup. Today, the team performs the procedures using local anesthesia, without central venous lines or bladder catheters, as part of a leaner pathway. Post-procedural care has evolved as well, with established processes around mobilisation and discharge.

“The procedure in the cath lab is typically only one hour,” Ole explains. The wider challenge lies in creating a smooth pre-procedural and post-procedural pathway around it. For Ole, one theme runs through the entire process. Preparation.
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It begins with communication. Patients need clear information about what will happen and what to expect afterwards. For an elderly patient who lives alone or a considerable distance from the hospital, discharge planning needs to begin before the procedure rather than the following morning.
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Procedural planning receives the same attention. Ole and his colleagues study cardiac CT in detail and identify potential challenges before entering the cath lab.

“We have a plan A, B, C, even sometimes a plan D.”

Preparation does not remove every uncertainty. It gives the team a stronger basis for responding when a procedure does not follow the expected course.
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EXPERIENCE DOES NOT REMOVE THE UNEXPECTED

Having performed thousands of procedures, Ole still encounters patients and anatomies which present new challenges. He sees this as an important part of medicine.

Technical knowledge provides a foundation, but clinical judgement develops through accumulated experience. Difficult cases, unexpected events and complications all contribute to what a physician brings into the next procedure.
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“You become better and better during your career because you have faced more challenges and discovered new or more elegant and efficacious solutions.”

For Ole, expertise therefore does not mean reaching a point where every procedure feels predictable. It means building experience from each challenge and applying it to the cases which follow.
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WHAT DEFINES A SUCCESSFUL TAVI HAS CHANGED

The definition of a successful TAVI has also evolved during Ole’s career. When TAVI was still a relatively new procedure, success centred primarily on avoiding major complications. If the patient survived without stroke or a major vascular complication, the procedure was considered successful. Over time, expectations have become more demanding. Physicians now look closely at valve performance, prosthesis-patient mismatch and conduction disorders, including the need for a pacemaker. Patient quality of life remains equally important.
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“Sometimes we also have to zoom a little bit out.”

Many patients treated for severe aortic stenosis also live with heart failure, atrial fibrillation, bleeding issues or other comorbidities. Successfully replacing the valve therefore represents one part of a broader clinical picture. Treating younger patients has added further considerations. Ole points to future coronary access, valve durability and the possibility of redo-TAVI eight or ten years later. The need for possible future treatment may already influence decisions made during the first procedure.
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The perspective has shifted from achieving a successful intervention today to considering how today’s intervention affects future treatment options.
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STRUCTURE SUPPORTS INDIVIDUAL DECISION-MAKING

Every patient is discussed within the Heart Team. Ole describes a multidisciplinary process where each specialist contributes a different perspective. The clinical cardiologist knows the patient’s clinical history, comorbidities, frailty and preferences. Interventional cardiologists contribute their CT analysis and assessment of procedural complexity. Surgeons, imaging specialists and transcatheter valve therapy nurses provide their expertise.
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The patient also plays an increasingly important role. When both TAVI and surgery represent appropriate treatment options, patient preference becomes part of the discussion. Ole describes this as a move away from the more paternalistic approach historically associated with medicine and toward greater involvement of the patient in the treatment decision.
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The process itself is highly structured. Every afternoon, an organised online Heart Team meeting gives the relevant specialists an opportunity to discuss patients. Over the course of a year, around 1,000 patients with valvular heart disease require this type of review. At this volume, Ole sees structure as essential.
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“This cannot be done in improvisation.”

A defined process allows multidisciplinary decision-making to happen consistently across a large number of patients. The same approach continues once the decision for TAVI has been made. Detailed CT assessment helps determine treatment approach, technology selection and the level of operator experience required. Transcatheter valve therapy nurses focus on the individual patient’s clinical needs, preparation and post-procedural pathway. For Ole, these elements need to come together before the procedure begins.
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“The planning part is, in structural heart, really the key for success.”

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EVEN EXPERIENCED OPERATORS STILL NEED TRAINING‍

Ole has also seen expectations around interventional training change significantly. Earlier in his career, young physicians often gained their first procedural experience directly on patients. He believes structured preparation before treating a patient now represents a more appropriate approach. Young physicians need to understand the materials, fluoroscopic angles and procedural steps involved. Simulation provides one environment where this knowledge and familiarity develop before clinical practice.
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Yet Ole does not see training as relevant only for younger physicians. As new mitral and tricuspid technologies reach the market, he still trains on simulators himself before using a new device in a case.
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“Even if I talk for myself, I may consider myself an experienced operator, it is for sure useful also for me and for very experienced operators to practice first: how does it react if I turn it clockwise or counterclockwise? Technologies become more advanced... you cannot be a master of all these therapies from the beginning. You must train yourself somewhere.”

For Ole, this need for preparation will only increase as structural heart technologies become more advanced, and the number of available therapies continues to grow.

EDUCATION HAS PLAYED A CENTRAL ROLE IN TAVI’S DEVELOPMENT

Ole believes the growth of TAVI over the past two decades reflects more than advances in technology. Education and training have played a major role. Physicians regularly visit his centre from hospitals across Europe and from countries including India and Brazil. Some visit for a day or a week. Others undertake a year of dedicated structural heart training. Ole says the centre has trained more than 56 fellows through this longer program.

The broader educational model includes theoretical and practical courses, simulation, observation at experienced centres and proctoring during complex cases. For Ole, a new technology alone is not enough, successful adoption also requires investment in the education and support surrounding the technology.
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“It’s having a good technology and investing heavily in education and training.”
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His advice to developing structural heart programs follows the same principle. Operators need to master implantation techniques and develop strong CT and 3D imaging skills. They need to seek education and ask for experienced support when facing challenging cases.
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“You have to really look for all the means you can to educate and train yourself.”

For unfamiliar procedures, he also sees value in gaining hands-on experience through simulation before moving into patient treatment.

THE NEXT CHAPTER OF TAVI

Looking ahead, Ole sees several areas requiring continued attention as TAVI moves further into younger patient populations.

Valve durability is one. Redo-TAVI is another.

As more patients return years after their first intervention, physicians increasingly need to understand how decisions made during the initial TAVI affect future treatment options.

Ole also identifies the treatment of younger patients with bicuspid anatomy as an important challenge for the field. For some hospitals, he sees further opportunities in the patient pathway itself. Differences remain in anaesthesia approaches, procedural setup and length of hospital stay. Improving these pathways offers another route toward more efficient TAVI care.
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Continued progress also relies on collaboration. Ole points to the longstanding interaction between physicians, engineers and MedTech companies as one factor behind the rapid development of structural heart intervention.
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Looking beyond TAVI to other advanced structural heart therapies, he also sees a need for stronger interaction between clinical teams, engineers, MedTech companies and regulatory organisations when developing, studying and introducing new technologies.
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EVERY PATIENT IN MIND

At the end of the conversation, Ole returns to the fundamentals of patient care. Timely diagnosis and treatment, multidisciplinary discussion. Patient preference, efficient and safe treatment. Clear communication throughout the process. For Ole, communication starts before the intervention and continues throughout the patient journey. Patients need to understand what lies ahead. Clinical teams need alignment around the treatment plan and the individual needs of the person they are treating.

The goal is clear.
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“To take the right decision for this patient and then go for a safe, efficient and as lean as possible treatment.”
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After thousands of TAVI procedures, Ole’s perspective remains centred on preparation, continuous learning and the individuality of every patient.

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ABOUT PROFESSOR OLE DE BACKER

Ole de Backer, MD, PhD, MBA

Professor of Interventional Treatment of Structural Heart Disease

Department of Cardiology, Rigshospitalet and University of Copenhagen (Rigshospitalet)

Ole de Backer is a senior consultant in interventional cardiology at Rigshospitalet and a professor at the University of Copenhagen. His clinical work primarily focuses on patients with structural heart disease, aortic disease and atrial fibrillation. His research focuses on structural interventional cardiology, including multimodality cardiac imaging and the development of new interventional techniques and technologies.

Originally trained in Belgium, Ole moved to Copenhagen for advanced interventional cardiology training in 2011. In the interview, he describes having performed thousands of TAVI procedures and working within a program expected to surpass 650 TAVI procedures in 2026.