Hybrid technique to bail out an unsuccessful transfemoral TAVR attempt

The most common route to perform transcatheter aortic valve replacement (TAVR) is via the transfemoral access. The success of this technique hinges on the successful passage of guidewires across the stenosed aortic valve. Although this is possible in the majority of cases, this case illustrates an occasional anomaly. In this report, we describe a novel hybrid technique involving a transseptal access as well as the formation of a continuous arteriovenous loop to complete the procedure successfully. This technique also has an additional advantage as it maintains the feasibility of performing the procedure under local anaesthesia and conscious sedation.