Renewed enthusiasm for treating aortic stenosis derives from a rapidly aging global population with increased disease prevalence as well as the emergence of new, less invasive therapies that have expanded patient treatment cohorts, namely transcatheter aortic valve replacement (TAVR). By several metrics, TAVR qualifies as a disruptive breakthrough technology; it addresses an unmet clinical need not well served by other therapies, is an innovative concept and novel device strategy, is validated by rigorous evidence-based clinical research, has been generalized to the practicing medical community, and elevates beyond subspecialty medicine and resonates as a significant sociomedical cultural advance. The accumulated clinical evidence on the value of TAVR from numerous well-controlled randomized trials and observational studies1-6 has strongly affected evolving society guideline recommendations.7,8 As we progress through the maturation phase of TAVR and begin to include varied patient cohorts, a compelling goal must be to optimize clinical outcomes and improve patient selection criteria. Although surgical risk stratification had been the previous standard for selecting appropriate patients for TAVR, an emerging trend is to identify anatomic and clinical factors that would more strongly favor either TAVR or surgery or palliative care as the preferred therapy.