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A man in his 60s with severe symptomatic aortic stenosis was scheduled for transcatheter aortic valve implantation (TAVI). His clinical workup showed bicuspid aortic morphology with a valve area of 0.7 cm 2, mean gradient of 48 mm Hg and preserved left ventricular function. He had a history of chronic obstructive pulmonary disease and chronic liver disease, resulting in oesophageal varices. He was deemed a high surgical risk by the Heart Team given his comorbidities. He was suitable for a transfemoral approach without prohibitive calcified aortic valve leaflets or raphe.