There was a reduction in repeat hospital- ization with TAVI (55% versus 72.5%; P<0.001). In addition, only 25.2% of survivors were in New York Heart Association (NYHA) class III or IV 1 year after TAVI, compared with 58% of patients receiving standard therapy (P<0.001). However, the rate of major stroke was higher with TAVI than with standard therapy at 30 days (5.05% versus 1.0%; P=0.06) and remained higher at vascular complications occurred in 16.2% with TAVI versus 1.1% with standard therapy Similarly, in a nonrandomized study of 489 patients with severe symptom- atic AS and extreme surgical risk treated with a self-expanding TAVI valve, the rate of all-cause death at 12 months was 26% with TAVI, com- pared with an expected mortality rate of 43% if patients had been treated medically.13 The final choice of TAVI versus palliative care is based on a shared decision-making process that accounts for the patient s values and preferences and includes discussion of the indication, risks, and benefits for and against each approach. 8. The survival and symptom reduction benefit of TAVI is seen only in appropriately selected patients. Baseline clinical factors associated with a poor outcome after TAVI include advanced age, frailty, smoking or chronic obstructive pulmonary disease, pulmonary hypertension, liver disease, prior stroke, anemia, and other systemic condi- tions. The STS estimated surgical risk score pro- vides a useful measure of the extent of patient comorbidities and may help identify which patients will benefit from TAVI. 