The last two decades of the transcatheter aortic valve replacement (TAVR) experience have been transformative and have led to a paradigm shift in the treatment of patients with severe aortic stenosis. While TAVR has become a “standard” procedure and is broadly implemented, its technical aspects and considerations continue to evolve, making TAVR-related decision-making more nuanced than ever. Multiple challenging anatomies, which require thorough and unique procedural planning to optimize outcomes, have been identified. Implantation of TAVR valves in large aortic annuli, specifically, can be challenging given the theoretical higher risk for paravalvular leak (PVL), valve embolization, and injury to the conduction system. Understanding how best to optimize TAVR outcomes in large-annuli patients has become even more important as the number of low-risk patients treated with TAVR continues to grow.