Hi, @matthew33. Here is a response from our experts: TAVR is approved for patients who are inoperable, high risk or intermediate risk patients for surgical aortic valve replacement. However, there are still issues that have not been clarified after TAVR; for example, valve durability, freedom from reoperation, and need for permanent pacemaker. Surgical aortic valve replacement is still the standard of care for patients with aortic stenosis. It is safe, well tolerated, and durable. Young, low-risk patients and patients who require other procedures such as surgery in another valve or bypass surgery, or who are not candidates for TAVR can be treated with surgery. Aortic valve replacement surgery can be performed minimally invasive through a 5- 6 cm incision either in the middle of the chest or through the right side of the chest. In addition, there are younger patients who may prefer open-heart surgery so they can rule receive a mechanical valve, which will not deteriorate with time. The TAVR is a tissue valve with a limited lifespan.