Continued advances in medical technology allow a growing number of the sick to be treated using new, minimally invasive techniques. One area that has received significant attention in recent years is transvascular replacement of stenotic aortic heart valves in the elderly. Transcatheter aortic valve replacement (TAVR, also referred to as transcatheter aortic valve implantation, or TAVI) involves delivery of a prosthetic heart valve through a remote access site, usually an artery. Candidate patients for this procedure are yet limited by regulatory agencies to those deemed inoperable or high risk for surgery. Such patients typically present with frailties that pose concern. Of particular note is thinning of the heart walls, especially near the left ventricular apex, that may be a normal anatomical feature or the result of previous myocardial ischemia. In either case, such thinning presents increased risk of perforation of those areas during placement of...

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