Alternative percutaneous approaches to the management of symptomatic aortic stenosis in elderly and high-risk patients have become more attractive and raised profound interest in recent years. The superiority of transcatheter aortic valve implantation (TAVI) compared with medical therapy for patients deemed unsuitable for surgery has recently been established by the PARTNER trial, and preliminary randomized data in high-risk patients have confirmed that TAVI is non-inferior to surgical valve replacement in terms of safety and effectiveness. This finding will probably lead to an exponential increase in TAVI procedures over the next decade. In the clinical setting of the percutaneous approach, the choice of a specific valve is crucial to optimize the success rate and minimize the procedure-related complications and requires accurate preprocedural diagnostic assessment. According to the high comorbidities of candidates currently undergoing a TAVI procedure, a tailored diagnostic framework in the elderly population is highly recommended. The present review discusses the role of echocardiography in the setting of multimodality imaging before the TAVI procedure and throughout the entire process, from patient selection to procedural guidance and post-procedural follow-up, suggesting a practical algorithm necessary for the best clinical outcome.