Technology for new surgical aortic valve replacement: current evidence and future directions

Surgical aortic valve surgery has stood the test of time as a reliable, reproducible, durable and readily available surgery using either mechanical or tissue or autologous valve technology. Performed well, the long-term results are excellent. All new heart valve related trials including catheter based [transcatheter aortic valve replacement (TAVR)] are compared to the conventional surgical aortic valve replacement (C-AVR). So why do we need new valves and techniques to insert aortic valves? What is driving this and why should we adopt them?