The Multidisciplinary, Multimodality, But Minimalist Approach to Transfemoral Transcatheter Aortic Valve Replacement

Inclusion criteria

Patients with severe symptomatic aortic stenosis undergoing elective transfemoral TAVR with a balloon expandable transcatheter heart valve

• Considered at increased surgical risk by the Multidisciplinary Heart Team.
• Informed written consent

Exclusion criteria

• Non -cardiovascular co-morbidity reducing life expectancy to < 3 years
• Any factor precluding 1 year follow-up
• Inadequate CT image acquisition to perform area-based annular CT sizing, exclude adverse root features, and determine a coaxial valve deployment angle (CT is not required for valve-in-valve procedures)
• Predicted inability to perform uncomplicated percutaneous vascular access and closure
• Iliofemoral diameter < 6 mm for SAPIEN XT or <5.5 mm for SAPIEN 3 (measured at or above the mid-femoral head)
• Inpatient (unless clinically stable, mobilizing at baseline, and primarily in hospital for logistical reasons.
• Significant communication barrier(s) that interfere with ability to follow peri-procedural and discharge instructions
• MMSE < 24/30 (unless language barrier or limited formal education), 5-metre gait > 7 seconds (unless chronic mobility impairment not affecting ability to perform ADLs), and ADL < 6/6
• Insufficient social support to facilitate next day discharge
• Airway unfavourable for emergent intubation
• Inability to lay supine without conscious sedation or general anesthetic
• Not receiving a balloon expandable transcatheter heart valve