Transcatheter aortic valve implantation (TAVI) is an effective treatment for patients with severe aortic valve stenosis and high operative risk.1 Despite its widespread adoption across the world, this procedure is still associated with several complications.2 Many of these, because their relatively high frequency (conduction disturbances, vascular complications, cerebrovascular events, paravalvular regurgitation, etc.), have been a field of deeper research aimed at defining potential predictive factors, clinical sequelae and procedural management.3–5 Nonetheless, TAVI has also been associated with very rare but life-threatening complications, such as coronary ostia obstruction and aortic rupture.6,7 Because of their extremely poor prognosis, prevention of these complications is of particular interest.
In this scenario, prosthesis type and size selection is part of the patient selection process that allows the operator to prevent these complications and finally determine procedural outcome.7,8 In this review, the techniques used either during pre-TAVI screening or during the procedure itself to avoid coronary occlusion and aortic rupture will be discussed.