Minimalist transfemoral transcatheter aortic valve replacement: Make it as simple as possible, but not simpler.

Transfemoral (TF) transcatheter aortic valve replacement (TAVR) has evolved dramatically. Improvements in technique, devices, operator's experience, and patient selection have resulted in markedly lower rates of procedural complications, thus allowing further technical simplification at every step of the procedure. Implementing a minimalist approach for TF TAVR (including transradial secondary access, angio-guidewire-ultrasound guidance for femoral puncture, and left ventricle guidewire pacing) may improve outcomes and reduce complications without compromising patient safety in contemporary clinical practice. Although this simplified approach is applicable for most patients undergoing TF TAVR, careful patient selection remains of paramount importance.