In 2007 the first patients in the United States were enrolled in clinical trials of transcatheter aortic valve replacement (TAVR) for severe symptomatic aortic stenosis. The initial trials enrolled patients that were not surgical candidates and over the following 10 years trials enrolled intermediate risk patients comparing TAVR with surgical aortic valve replacement (SAVR) and lastly came the holy grail, the randomization of low risk patients . On August 16, 2019 the United States Food and Drug Administration approved TAVR for low risk patients with symptomatic severe aortic stenosis thus allowing TAVR to be performed in any risk group. Approval was based on two pivotal trials that confirmed superiority (PARTNER [Placement of Aortic Transcatheter Valves] or noninferiority (Evolut Low Risk [LR]) ) of TAVR versus SAVR. Following initial outcome data from the clinical trials, identification of risk groups most likely to benefit from this revolutionary technology ensued. Possibly even more important was the identification of patients who would not receive benefit or would receive less benefit from TAVR.