The balance between expected patient longevity and valve durability varies continuously across the age range, with more durable valves preferred for patients with a longer life expectancy. Bioprosthetic valve durability is finite (with shorter durability for younger patients), whereas mechanical valves are very durable but require lifelong anticoagulation. Long-term (20-y) data on outcomes with surgical bioprosthetic valves are available; robust data on transcatheter bioprosthetic valves extend only to 5 y, leading to uncertainty about longer-term outcomes. The decision about valve type should be individualized on the basis of patient-specific factors that might affect expected longevity. A large aortic annulus may not be suitable for currently available transcatheter valve sizes. With a small aortic annulus or aorta, a surgical annulus-enlarging procedure may be needed to allow placement of a larger prosthesis and avoid patient prosthesis mismatch. Dilation of the aortic sinuses or ascending aorta may require concurrent surgical replacement, particularly in younger patients with a BAV. AF indicates atrial fibrillation; AS, aortic stenosis; BAV, bicuspid aortic valve; CAD, coronary artery disease; LV, left ventricular; MR, mitral regurgitation; QOL, quality of life; SAVR, surgical aortic valve replacement; and TAVI, transcatheter aortic valve implantation. Modified from Burke et al.16 CLINICAL STATEMENTS AND GUIDELINES moderate reduction in the transvalvular pressure gradient, but the postdilation valve area rarely . Despite the modest change in valve area, an early symptomatic improvement usually occurs. However, serious acute compli- cations, including acute severe AR, restenosis, and clinical deterioration, occur within 6 to 12 months in most patients. Therefore, in patients with AS, percutaneous aortic balloon dilation is not a substitute for AVR. 