Patient selection—risk assessment and anatomical selection criteria for patients undergoing transfemoral aortic valve implantation

Currently percutaneous aortic valve replacement (PAVR) is indicated for patients at high surgical risk or for inoperable patients. Preprocedural evaluation is crucial to select the patients who will benefit the most and have the procedure done safely. This review will focus on risk assessment and the value of the available risk score systems, and on the screening process, which is the key for success in PAVR. Because of the large delivery system, careful evaluation of iliofemoral vessels is crucial. It is important to know the amount of atherosclerosis and plaque in the aortic arch and ascending aorta for potential risk for neurological events. Accurate measurement of aortic annulus diameter and coronary arteries origin before the procedure is important. Specific coexistent conditions can influence the procedure, such as left ventricular function or left ventricular hypertrophy with narrow outflow tract. Assessment of all these components is necessary for procedural planning of access approach, valve sizing, and deployment.