Radial Versus Femoral Secondary Access During TAVI

Inclusion Criteria: 1\) Patient meets eligibility for TAVR as decided upon by pre-TAVR testing (Echo, cardiac catheterization, CTA TAVR, 2 CT surgical consults, heart team discussion). 2) Undergoing TAVR procedure and follow-up at Carilion Clinic Cardiology Roanoke Memorial Hospital (CRMH) 3) Patient's secondary vascular access can be performed femorally OR radially, as determined by TAVR operator after review of pre-TAVR CT scan imaging. 4\) Interventional Cardiologist performing the TAVR agrees to consider patient for enrollment. 5\) Patient provides consent 6) Age ≥ 18 years old 7) No evidence of precluding arterial disease of both femoral arteries 8) No evidence of precluding arterial disease of right radial and subclavian arteries 9) Must have palpable pulses in both radial arteries Exclusion Criteria: 1. Review of pre-TAVR CT scan imaging deems patient unsuitable for radial OR femoral secondary access based on presence of excessive calcification, stenosis, or tortuosity of the femoral, subclavian, or innominate arteries. 2. Valve implantation (primary access) planned via alternative vascular access (trans-caval, axillary, carotid, direct aortic, trans-apical)-as determined by implanting Interventional Cardiologist/TAVR operator. 3. Prior coronary artery bypass graft surgery in which a radial artery graft was harvested and used as a conduit. 4. Patients on hemodialysis OR with arteriovenous fistulas. 5. Interventional Cardiologist performing the TAVR declines patient consideration in the study. 6. Patient declines consent. 7. Urgent or emergent TAVI cases 8. Patient is already participating in another clinical research study