For young patients (eg, <65 years of age) who opt for a surgical bioprosthesis, strategies for se- quential procedures over a longer follow-up period (ie, valve-in-valve [ViV] TAVI versus reoperation) must be addressed. Recommendation-Specific Supportive Text 1. The decision to intervene, as well as the type of procedure recommended, is based on an assess- ment of patient-, procedure-, and institution- or operator-specific short-term risks and long-term benefits (Table 8). Surgical mortality rate and major morbidity risks can be calculated with a web- based tool derived from the Society of Thoracic Surgeons (STS) Adult Cardiac Surgery database for 6 specific procedures (http://riskcalc.sts.org/ stswebriskcalc/calculate). TAVI-specific risk predic- tion tools are also available (http://tools.acc.org/ Frailty assess- ment for at-risk patients is routine.7 11 Patients toward the higher end of the risk spectrum, for whom intervention would be futile or associated with a high likelihood of a poor outcome, should Table 8. 