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 1. Considered at increased surgical risk by the Multidisciplinary Heart Team. 2. Informed written consent Exclusion Criteria: 1. Non -cardiovascular co-morbidity reducing life expectancy to \< 3 years 2. Any factor precluding 1 year follow-up 3. 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) 4. Predicted inability to perform uncomplicated percutaneous vascular access and closure 5. Iliofemoral diameter \< 6 mm for SAPIEN XT or \<5.5 mm for SAPIEN 3 (measured at or above the mid-femoral head) 6. Inpatient (unless clinically stable, mobilizing at baseline, and primarily in hospital for logistical reasons. 7. Significant communication barrier(s) that interfere with ability to follow peri-procedural and discharge instructions 8. 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 9. Insufficient social support to facilitate next day discharge 10. Airway unfavourable for emergent intubation 11. Inability to lay supine without conscious sedation or general anesthetic 12. Not receiving a balloon expandable transcatheter heart valve