**1. Introduction**

Aortic stenosis (AS) is the most frequent type of valvular heart disease in Europe and North America. It mainly presents as calcified aortic stenosis in older adults (2-7% of the popula‐ tion> 65 years), which is the most common cause of valve replacement in the western world. Its incidence increases with age [1]. With the increasing age and life expectancy of the popu‐ lation, an increase in the prevalence of aortic stenosis had been observed. Furthermore, the elderly patient usually presents multiple comorbidities associated with increased surgical risk. Aortic valve replacement (AVR) is currently the treatment of choice in patients with symptomatic aortic stenosis and/or left ventricular systolic dysfunction (see Indications for surgery), even though some cases present high or extremely high surgical risk.

Our goal is to update the treatment of severe aortic stenosis in high-risk patients, mainly the elderly and those cases where risk assessment scales indicate a high- or very high-risk pa‐ tient. Here we analyse the role of new therapeutic approaches in the treatment of these pa‐ tients and their short and long-term results, as well as the use of new devices and prosthesis.
