In critically ill patients with severe AS, percutaneous aortic balloon dilation may be considered as a bridge to SAVR or TAVI. Synopsis In patients considering a bioprosthetic AVR, the next step is the choice between SAVR and TAVI. In patients with a high or prohibitive risk for SAVR (see Section 2.5), decision-making focuses on TAVI versus pallia- tive care. When surgical risk is not high or prohibitive, procedure-specific impediments are assessed (Fig- ure 3). When both SAVR and TAVI are options, a prime consideration is the limited data about TAVI durabil- ity. SAVR has been used for more than 50 years, with ample durability data available for specific valve types across different age groups. Currently, robust durabil- ity data for TAVI extend to only about 5 years. SAVR valve deterioration typically occurs after >10 years, so longer-term TAVI durability data are needed. A key factor in decision-making is the ratio of patient life expectancy to known valve durability, with patient age often used as a surrogate for life expectancy. For a woman in the United States, the average additional expected years of life are 25 at age 60 years, 17 at age 70 years, and 10 at age 80 years. For a man, expected additional years of life are 22 at age 60 years, 14 at age 70 years, and 8 at age 80 years. The age break- points shown in these recommendations reflect these Recommendations for Choice of SAVR Versus TAVI for Patients for Whom a Bioprosthetic AVR Is Appropriate (Continued) COR LOE Recommendations CLINICAL STATEMENTS AND GUIDELINES Figure 3. Choice of SAVR versus TAVI when AVR is indicated for valvular AS. Colors correspond to Table 2. *Approximate ages, based on US Actuarial Life Expectancy tables, are provided for guidance. 