**1. Introduction**

The management of aortic valve disease has undergone a dramatic transformation over the past 10 years. Without a doubt there has been significant developments in the diagnostic and management tools available to assess patients with aortic valve pathology. In addition to these tools are better and safer surgical techniques, especially with regards to anesthesia, myocardial protection, and peri-operative care, as well as the means in which patients can be risk-assessed to help guide decisionmaking. However, despite these advances, patients presenting with significant valvular disease are getting older and often will have substantial and more complex co-morbidities that place them at significant risk for challenging short- and longterm adverse outcomes. The goal of this text is to illustrate some of the challenges and controversies, with an emphasis on a surgical perspective, regarding the diagnosis and management of one of the most common forms of degenerative valve disease – aortic stenosis. While, by no means, is this a comprehensive review, it does provide a foundation and potential paradigm for how we evaluate, manage, and study valve disease both at a patient as well as a population level.
