A 76-year-old man underwent isolated aortic valve replacement (AVR) in 1986 for nonrheumatic AS with a 23-mm Carpentier-Edwards valve. During 2007 he became increasingly dyspneic and was found to have severe aortic regurgitation (AR) with moderate AS. His renal function was impaired (creatinine 201 mmol/l, estimated glomerular filtration rate 28 ml/min), and given his resultant high operative risk score (logistic EuroSCORE 19%), he was referred for TAVI. Transthoracic echocardiography confirmed severe eccentric aortic regurgitation, and the “aortic annulus” measured 21 mm. The procedure was performed under conscious sedation as previously described (6). The right radial artery was cannulated, and a 5-F pigtail catheter was advanced to the aortic root. A 4-F balloon flotation temporary pacing wire was placed via the right internal jugular vein. With the left common femoral approach, the arterial access was prepared for closure with the Prostar (Abbot Vascular Devices, Redwood City, California). The valve was crossed with an Amplatz L1 (Cordis Corp., Miami, Florida) catheter, a hand-curved J-tip Amplatz SuperStiff guidewire (Boston Scientific Corp., Miami, Florida) was coiled in the left ventricle, and an 18-F Cook sheath was introduced over the wire. Without valvular pre-dilation, a 26-mm CoreValve (Medtronic) was introduced and positioned under fluoroscopic guidance, with concurrent pacing at 150 beats/min to limit the effects of aortic regurgitation on valve advancement during deployment. Aortography and hemodynamic monitoring confirmed resolution of the aortic regurgitation (Figure 1). There was no gradient across the new bioprosthesis on invasive assessment. The femoral access site was closed with the pre-laid ProStar suture pair. A post-procedure echocardiogram the next day showed normal functioning of the supra-annular valve, with a peak flow velocity of 2.7 m/s across it, and trivial aortic regurgitation.