LAUSR

Transcatheter aortic valve replacement (TAVR) has evolved through many stages since its inception two decades ago. In the early days of TAVR, 22 – 24 ‐ French delivery sheaths were needed to deliver the first ‐ generation valves. This resulted in a high rate of vascular and bleeding complications with femoral access and was directly related to increased morbidity and mortality. 1 Moreover, these sizeable ‐ bore delivery systems required adequate size femoral/iliac arterial vasculature that is relatively free of disease. This was a limitation in certain patients necessitating alternative vascular access, or the use of transapical access which was more invasive and associated with a prolonged hospital stay. Ever since, efforts have been made to improve the design and the profile of the transcatheter valve delivery system to simplify the procedure and lower the complication rates, especially access site complications. Furthermore, the trend toward a “ minimalistic ” approach to TAVR has been gaining momentum, with the transition from general anesthesia to conscious sedation, use of TTE instead of TEE, and minimizing vascular access sites including rapid pacing through the TAVR ventricular guidewire to avoid separate venous access.