In summary, the use of LA for TAVI procedures has the potential to significantly reduce resource consumption. The available data consistently supports this and there has been no suggestion that this comes at the price of unfavourable outcomes. Data, however, are few and far between, largely single-centre and all registry (nonrandomised) based, with all the problems inherent in these sorts of publications. Although a dedicated randomised trial seems unlikely, data from national databases and subgroup analyses of international randomised trials should provide sufficient information for TAVI operators to decide if LA should be the default for the relevant access routes and, if this is the case, who are the exceptions where a GA is required.