In patients unsuitable for transfemoral transcatheter aortic valve implantation (TF-TAVI) due to peripheral artery disease, another route such as trans-subclavian-axillary or transcarotid is a becoming alternative. The novel Myval transcatheter heart valve system technology is a second-generation balloon-expandable valve described by design innovations that promote accurate positioning of the valve and warrant accurate orthotopic valve deployment. To our knowledge, this is the first case report in the literature of successful transcarotid TAVI via the novel balloon-expandable Myval THV system under the local anesthesia for heavily calcific and stenotic abdominal aorta and subclavian arteries.