Conventional transcatheter aortic valve replacement (TAVR) relies on fluoroscopic and contrast agents. However, in high-risk patients, exposure to ionizing radiation and contrast agents is contraindicated and undesirable. Echocardiography guidance TAVR can offer a feasible and safer strategy for TAVR.

Inclusion Criteria:

1. symptomatic severe AS determined by echocardiography and Doppler that requiring aortic valve replacement, which is defined as: mean gradient ≥40 mmHg, peak aortic velocity ≥4 m/s, and aortic valve area (AVA) ≤1 cm2 (or an indexed AVA ≤0.6 cm2/m2);
2. a history of malignancy or a high familial risk of cancer, with refusal to undergo contrast- or radiation-guided procedures;
3. chronic kidney disease and refuse to receive contrast agents or radiation exposure.

Exclusion Criteria:

Required hybrid procedures or concomitant interventions on other cardiac malformations; Deemed inoperable due to extremely high surgical risk or severe comorbidities; Had untreated clinically significant coronary vascular disease amenable to revascularization; Previously undergone aortic valve replacement.

Eligible patients included those with symptomatic severe aortic stenosis confirmed by echocardiography (mean gradient ≥40 mmHg, peak velocity ≥4 m/s, and AVA ≤1 cm² or indexed AVA ≤0.6 cm²/m²), individuals with a history or strong family history of cancer who refused contrast- or radiation-guided procedures, and patients with chronic kidney disease unwilling to receive contrast agents or radiation exposure. Patients were excluded if they required hybrid procedures or other cardiac interventions, were deemed inoperable due to extremely high surgical risk or severe comorbidities, had untreated significant coronary artery disease suitable for revascularization, or had previously undergone aortic valve replacement.