The first transcatheter aortic valve implantation (TAVI) performed by Alain Cribier and his team in 2002 in Rouen was the first unbelievable step of a revolution in the treatment of severe symptomatic aortic stenosis. During the next 20 years, the refinement of TAVI with the evolution of transcatheter heart valve (THV) and their delivery system, shared experience, very active research and development of multi-slice computer tomography (MSCT) was associated with a simplification of the procedure and a very high rate of success and low risk of complication. Indication of TAVI moved progressively from contraindication to high risk, intermediate risk and today low risk of surgery in patients who are good candidates for femoral approach with a native valve anatomy at low risk of complication. Today, the majority of TAVI patients are still old with comorbidities and therefore are at high risk of bleeding (HBR). The simplification of the procedure is also a very important issue in this context. It starts with a prepared and organized optimal screening including MSCT and coronary angiogram, if necessary (outpatient or very short hospital stay), then the procedure is planned and performed in the cath lab on conscious sedation using percutaneous femoral approach for THV delivery and radial approach for the secondary access, limiting the amount of contrast media, implanting the THV without predilatation in the majority of cases and using the left ventricle wire for rapid pacing. Early mobilization of the patient at 4 hours when possible is part of the strategy to shorten the hospital stay. Finally, in this HBR patients, antithrombotic treatment should be limited to one antiplatelet treatment only or the previous ongoing anticoagulant treatment in patients who had no recent coronary stent implantation.