**2. Preoperative assessment and planning**

Potential TAVI patients must undergo full evaluation with


Initial TAVI evaluation should include an assessment of the following variables also:


Patients with severe coronary artery disease and lesions which are treatable by percutaneous coronary intervention should get stents prior to the procedure. We keep patients on dual anti platelets therapy for about 6 weeks and then take them for TAVI.

The aortic annulus is sized at mid-systole, and the valve size is selected based upon 10% over-sizing of the annular diameter.

If the annulus is not adequately sized, there would be risk of improper valve size selection that could lead to paravalvular leak, valve embolization, coronary obstruction if the sinus of Valsalva is small or the distance between the annulus and the coronary ostia is less (<10 mm).

**7**

**Figure 2.**

*Transfemoral access for TAVI.*

*Different Sites of Vascular Access for Transcutaneous Aortic Valve Implantation (TAVI)*

cations depending on vascular size, tortuosity and calcification [5].

ally more than 6.5 mm) and it should be free of calcification

Transfemoral access (**Figure 2**) is the most preferred route in majority of the TAVI procedures world over [4] unless there is an increased risk of vascular compli-

• All patients should undergo a CT-angiographic scan with 3D reconstruction of

• Aorta should be assessed for tortuosity, presence of aneurysms, atherosclerotic

• Minimum size of femoral and iliac arteries should be more than 5.5 mm (ide-

• Some studies shown that a sheath to femoral artery ratio of greater than 1.05 is

• Bifurcation of femoral artery and its relation with the femoral head should be

• Site of needle entry may be altered based on CT scan or ultrasound findings of high bifurcation of the common femoral artery and presence of significant

• A circumferential calcification could be a potential contraindication for

*DOI: http://dx.doi.org/10.5772/intechopen.84533*

aorta and femoral vessels

transfemoral approach

evaluated properly

calcium.

plaques and aortic arch calcifications

predictive of a vascular complication [6]

**3. Transfemoral access**

**3.1 Introduction**

**3.2 Planning**
