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Owing to continuous advances in both cardiovascular surgery and interventions, there is nowadays a whole range of therapeutic options that can be offered to patients with valvular heart disease. In the case of aortic valve stenosis, patients without major co-morbidities can undergo surgical aortic valve replacement (AVR) at a very low surgery-related risk for major adverse events. On the other end of the spectrum, patients who are judged to be too sick to undergo surgery might benefit from transcatheter aortic valve implantation.1While the reduction in procedure-related complications is an important advance over the state from a few decades ago, the decision-making process leading to valve replacement is still based on the same mechanistic concepts that were used at the time when valve replacement surgery first became available. Specifically, parameters such as pressure gradients, regurgitant fractions, and ventricular volumes are taken into account in order to estimate the impact of valvular …

Assessment of diffuse myocardial fibrosis in aortic valve stenosis: let's get personal