In running a structural heart program, we are frequently asked to take on exceptional clinical challenges, often for which there has been no (or very little) precedent.

Sydney Heart Team principal, Professor Michael Vallely, describes how to establish a TAVI program in the attached paper. 

Within the spectrum of high-risk patients with aortic stenosis, some patients are of exceptional risk. They often have very weak hearts that predispose them to prohibitive risks of mortality when undergoing TAVI.

While most keyhole (transcatheter or percutaneous) aortic valve implant procedures are done through an artery in the groin (femoral artery), a significant number of patients have narrowed arteries in the leg or arteries that are too small, thereby precluding this approach.