**1. Introduction**

The appropriate management of patients with aortic valve disease is perhaps one of the most debated topics. Unlike the mitral valve, management of aortic valve disease is a more delicate process as poor decisions can lead to chronic strain on the left ventricle, development of aortic insufficiency, high re-intervention rates, morbidity, and mortality. For many patients, the first arguable decision is between balloon valvuloplasty and surgical repair. Balloon valvuloplasty has evolved over many decades and is a reliable and straightforward procedure for any patient who needs immediate relief of a stenosed aortic valve. On the other hand, emerging aortic valve repair techniques have also shown satisfactory results for the management of aortic valve disease. However, repairs in severely dysplastic unicuspid and bicuspid valves are still evolving, and though promising results are seen in some studies, its utility long-term, especially in the pediatric population, is still unknown. Aortic valve replacement techniques have also improved throughout the years and have been the method of

choice for some irreparable dysplastic valves. As more technically challenging repair and reconstruction techniques are developed throughout the years, it is imperative to understand if repair or replacement is a better option for certain patient populations.

This chapter will review current literature and attempt to address the following gaps: 1) Is balloon valvuloplasty or surgical valvulotomy more superior? 2) What repair techniques are available for management of aortic valve disease? 3) What are the available options for aortic valve replacement? 4) Is aortic valve repair superior to replacement, or is it just another way to delay aortic valve replacement?
