Decision-making should be indi- vidualized on the basis of patient-specific factors that affect longevity or quality of life, such as comorbid cardiac and noncardiac conditions, frailty, dementia, and other factors. In addition, the choice of implanta- tion approach is based on a shared decision-making process that accounts for the patient s values and pref- erences and includes discussion of the indications for and against each approach and the potential need for and risks associated with valve reintervention.16 19 Recommendation-Specific Supportive Text 1. SAVR has demonstrated excellent durability and outcomes for both mechanical and bioprosthetic valves. Earlier RCTs comparing SAVR and TAVI in patients with a higher surgical risk included only older patients, with a mean age in the mid-80s. More recent RCTs that included patients at low to intermediate surgical risk had a mean age in the mid-70s, but there were very few patients <65 years of age, so the evidence base cannot be extrapolated to these patients. In addition, valve durability is of higher priority in younger patients, who typically have a longer life expec- tancy and lower surgical risk. As longer-term data on TAVI valve durability become available, the age range for recommending TAVI may shift, but at this time the most prudent course, based on the published evidence, is to recommend SAVR for adults <65 years of age unless life expectancy is limited by comorbid cardiac or noncardiac condi- tions. The final choice of implantation approach is based on a shared decision-making process that accounts for the patient s values and preferences and includes discussion of the indications for and against each approach and the potential need for and risks associated with valve reintervention. There are no data for the use of TAVI in patients 2. 