Transaxillary TAVR With Solely Echocardiography Guidance

Inclusion Criteria: 1. symptomatic severe AS determined by echocardiography and Doppler that requiring aortic valve replacement, defined as: mean gradient ≥40 mmHg, peak aortic velocity ≥4 m/s, and aortic valve area (AVA) ≤1 cm2 (or an indexed AVA ≤0.6 cm2/m2) 2. suitable for Transaxillary TAVR Exclusion Criteria: 1. required hybrid procedures or concomitant interventions on other cardiac malformations 2. inoperable due to extremely high surgical risk or severe comorbidities 3. untreated clinically significant (\>70% obstruction) proximal vessel coronary vascular disease amenable to revascularization 4. previously undergone aortic valve replacement.