Balloon Dilatation of Expandable Sheath to Facilitate Transfemoral SAPIEN 3 Transcatheter Aortic Valve Replacement in Severely Calcified Vasculature.

•Although the dynamic expansion mechanism allows transient enlargement of the Edwards Commander Delivery System, in severely calcified and stenotic iliofemoral arteries, the eSheath may not be able to expand adequately during the transcatheter heart valve advancement to allow a smooth passage.•Excessive push force may be necessary to engage the dynamic expansion mechanism to advance the transcatheter heart valve but may risk damaging the transcatheter heart valve as shown during our initial case. Worse yet, the transcatheter heart valve may get stuck, and major vascular complication may occur from removing the Edwards Commander Delivery System and expanded eSheath together.•As demonstrated in our case series, predilatation to expand the eSheath is safe with no downside but can ensure smooth passage of the balloon-expandable transcatheter heart valve to avoid potential major vascular complication.