Aortic valve lesions are common valvular diseases and their treatment is currently mainly aortic valve replacement (AVR). For decades, conventional aortic valve replacement has been efficacious and safe and mature, and the operative mortality rate is stable at about 1% in a cardiac center like Fu Wai Hospital. However, for patients of advanced age, with other comorbidities and high surgical risk, who cannot tolerate the trauma and shock of conventional surgery, there are a significant number of patients, who cannot undergo conventional surgery. Some data show that in Europe, a significant percentage of high-risk valve patients are not recommended for surgery by both physicians and patients. Of course, for some patients, fear of extracorporeal surgery and wounds is also a reason for their reluctance to undergo conventional surgery. In recent years, percutaneous heartvalvereplacement (PHVR) has emerged as a popular procedure. A cursory personal survey of the literature shows that by the end of 2007, more than 1,000 patients had undergone percutaneous aortic valve replacement. Currently, the main patients are those with aortic stenosis. In 1992, the feasibility of transcatheter implantation of prosthetic aortic valves was demonstrated in a pioneering study by Andersen et al. In 2002, the first percutaneous human aortic valve transplantation was completed by Cribier et al. A transballoon stent-released bovine pericardial aortic valve device was successfully implanted, which successfully initiated the clinical application of percutaneous aortic valve replacement. Implantation pathway: 1.Cis-approach: puncture right femoral vein-right atrium-atrial septum-left atrium, via mitral valve and left ventricular outflow tract to ascending aorta, and release the valve. 2, Retrograde method: puncture of the femoral artery – abdominal aorta – descending aorta – aortic arch – retrograde to the aortic root – left ventricle. 3.Transcatheter apical. A small incision on the left side of the sternum is made to reveal the apex of the heart, the apical part of the left ventricle is made to be ruffled, punctured, a guidewire track is established, and the valve is released by the prograde method to complete the aortic valve replacement. This method does not use the traditional extracorporeal circulation, does not need to open the chest, and has small surgical trauma. At present, percutaneous aortic valve replacement has entered phase 1 clinical trials. Mainstream products 1.Cribier-Edwards biologic valve, made of bovine pericardium. The stent is 14 mm long and can avoid the coronary artery orifice and anterior mitral leaflet, with an orifice area of 11.71 cm, and can be inserted in a prograde or retrograde manner; 2, CoreValve bioprosthesis, attached to a self-expanding nickel-titanium stent, 21F can be used in patients with an ascending aorta up to 45 mm. It can only be inserted retrograde via the arterial route. TIPS: 1. Deliver the stent balloon to the position marked by the calcified aortic annulus shown on the left ventriculogram. 2. Deflate the balloon to release the stent valve after the expansion balloon fixes the stent. 3, Never pay attention to the position of the coronary artery. Do not obstruct the coronary artery. This point is the key point of the operation. 4, avoid pulling the anterior mitral valve leaflet, resulting in severe mitral regurgitation. 5.There are two types of percutaneous valves, 23mm and 26mm, which are generally replaced with valves slightly larger than their own aortic annulus. Generally, the 23-mm stent valve is used for an 18- to 22-mm annulus and the 26-mm stent valve is used for a 19- to 24-mm annulus. Intraoperative monitoring: 1. Angiography. Preferably in a hybridized operating room. 2, TEE. 3, Real-time MRI. Complications of percutaneous aortic valve replacement (1) Complications related to the stent valve: stent valve dislodgement, perivalvular leakage, coronary artery orifice occlusion; (2) Complications of interventional procedures: mitral valve injury, arterial injury, stroke.