“My daily dilemma is not, which patient should have TAVR but who should have a surgical AVR and why?” —Thomas Modine

1. In elderly patients >75 years of age, TAVI is superior to medical therapy in extreme risk patients, noninferior or superior to surgery in high risk patients and noninferior or even superior to surgery when transfemoral access is possible in intermediate risk patients (2017 ESC/EACTS guidelines for the management of valvular heart disease).
2. In patients with severe aortic stenosis at intermediate surgical risk, TAVR was a noninferior alternative to surgery (N Engl J Med. 2017;376(14):1321-31).