Wise decisions, good results.

Transcatheter valve aortic implantation (TAVI) is undoubtedly one of the most notable advances in the treatment of heart disease. Its results have been repeatedly confirmed in randomized trials comparing TAVI with conventional surgical aortic valve replacement and in registries, in patients with varying degrees of surgical risk (moderate, high, very high or prohibitive), and it will presumably continue to play an important role in the near future. There are, however, certain aspects of the technique that need to be improved in order to obtain even better results. Problems of vascular access due to the need for much larger sheaths than those usually employed in interventional cardiology are among the main causes of morbidity, mortality and prolonged hospitalization in these patients. There have been important publications on this subject, as well as presentations at conferences of works from various centers. The main causes of vascular complications of TAVI are generally identified as the sheath-to-iliofemoral artery ratio (SIFAR), vessel size, calcification of the vessel wall as measured by the calcium score, vessel tortuosity and the presence of plaques on the wall, operator experience and expertise, procedure time, and patient characteristics, particularly female gender.