<p id="hl0000077" class="ng-scope">Transcathether aortic valve implantation (TAVI) for symptomatic severe aortic stenosis (AS) has been approved in patients across all surgical risk profiles and is associated with improvement in survival, quality of life, and functional status<span> </span><button class="j-inline-reference inline-reference" data-refid="bb0005" id="refInSitubb0005">[1</button><button class="j-inline-reference inline-reference" data-refid="bb0010" id="refInSitubb0010">2]</button><span> </span>.</p> <p id="hl0000079" class="ng-scope">However in asymptomatic severe AS, a watchful waiting strategy for onset of symptoms or left ventricular (LV) dysfunction is recommended, as the mortality risk of aortic valve replacement (AVR) is believed to exceed that associated with active surveillance (1.0% estimated annual risk of sudden cardiac death)<span> </span><button class="j-inline-reference inline-reference" data-refid="bb0015" id="refInSitubb0015">[3]</button><span> </span>. Per the current American College of Cardiology/American Heart Association guidelines, AVR for asymptomatic severe AS is indicated in: 1) Left ventricular ejection fraction (LVEF) <50%. 2) Abnormal exercise test. 3) Low surgical risk with very severe AS (aortic peak velocity >5.0 m/s) OR with rapid progression (peak transvalvular velocity progression >0.3 m/s per year) OR elevated brain natriuretic peptide. In addition, only transfemoral TAVI is recommended in those with LVEF <50% and age ≥65 years<span> </span><button class="j-inline-reference inline-reference" data-refid="bb0015" id="refInSitubb0015">[3]</button><span> </span>. With the emergence of new methods of risk stratification for asymptomatic AS patients, waiting for symptom onset or LV dysfunction to trigger intervention may result in irreversible structural and functional myocardial impairment leading to suboptimal outcome after intervention. This is further accentuated in patients who cannot be followed up closely and in those with delayed reporting of symptoms, which can often be challenging to ascertain in elderly, sedentary, and/or deconditioned patients. New York Heart Association functional class (NYHA-FC) as a physician-reported measure of patient-reported symptoms has been consistently used in clinical trials for characterizing the baseline functional status of patients with severe AS, and may have prognostic implications among patients undergoing TAVI.</p>