Image-guided interventional systems become an essential part of the modern minimally invasive surgical procedures, especially for the cardiac surgery. Transapical aortic valve implantation (TAVI) is a recently developed surgical technique to treat severe aortic valve stenosis in elderly and high-risk patients. The placement of stented aortic valve prosthesis is crucial and typically performed under live 2-D fluoroscopy guidance. To assist the placement of the prosthesis during the surgical procedure, a few image-guided TAVI systems have been developed. This work therefore presents current difficulties and challenges of these guidance systems, with consideration of future prospects.