We have learned through maturing practices in aortic stenosis that deciding on transcatheter aortic valve replacement vs surgical aortic valve replacement by using only anatomic limitations and surgical risk is overly generalizing and may not offer the best for all patients. Instead, lifelong management of the valve is increasingly weighing in, especially in the younger patient. The index procedure is being designed to avoid a repeat intervention, or if necessary, to set up the patient for a successful repeat intervention during the expected lifetime.