TRanscatheter Aortic-Valve Implantation With or Without On-site Cardiac Surgery: the TRACS Trial

Inclusion Criteria: * Severe aortic stenosis * Indication to TAVI confirmed by the Study Heart Team AND one of the following: * Inoperable due to prohibitive operative risk * High surgical risk as defined as STS score \>8% The presence of at least one clinical factor that, by unanimous judgment of the Study Heart Team, compromises the benefit/risk ratio in the case of emergent cardiac surgery: * Porcelain aorta or severely atherosclerotic aorta * Frailty/Reduced physical performance * Cognitive impairment, dementia, or Parkinson's disease * Severe liver disease/cirrhosis * Hostile chest * Internal mammalian artery or other critical conduit(s) crossing midline and/or adhering to the posterior table of the sternum * Severe pulmonary hypertension and/or severe right ventricular dysfunction * Severe Chronic Obstructive Pulmonary Disease (COPD) * Age ≥85 years Exclusion Criteria: * Unsuitable for transfemoral TAVI * Emergent TAVI * Noncardiovascular comorbidity reducing life expectancy to \<1 year * Any factor precluding 1-year follow-up * Refusal informed consent