The mortality rate for transfemoral TAVI is lower than that for SAVR, with a HR of 0.88 and a 95% CI of 0.78 to 0.99 in a meta-analysis of RCTs. TAVI also is asso- ciated with a lower risk of stroke (HR: 0.81; 95% CI: 0.68 0.98; P=0.028), major bleeding, and AF, as well as a shorter hospital length of stay, less pain, and more rapid return to normal activities.3 Compared with SAVR, TAVI results in higher rates of vascular complications, paravalvular regurgita- tion, permanent pacemaker implantation, and valve intervention, but most patients will consider that the advantages of TAVI outweigh these dis- advantages. TAVI valves are durable to at least 5 years, and the limited data on TAVI durability are of less concern to most patients >80 years of age because the valve durability is likely to be longer than the patient s life expectancy.22 If significant valve deterioration does occur, a second TAVI within the first prosthesis, (called a valve-in-valve TAVI), is likely to be possible. When a transfemo- ral approach is not possible, other factors, such as alternative vascular access, comorbid cardiac and noncardiac conditions, expected functional status and survival after AVR, and patient values and preferences, must be considered. The spe- cific choice of a balloon-expandable valve or self- expanding valve depends on patient anatomy and 4. An LVEF <50% in a patient with severe AS is a COR 1 indication for AVR, so the choice of TAVI versus SAVR in these patients is based on the same considerations as in patients with symptoms CLINICAL STATEMENTS AND GUIDELINES attributable to severe AS. 