The article by Sack and co-workers published in this issue presents the results of a retrospective study on the treatment of severe calcified aortic stenosis (AS) by means of balloon aortic valvuloplasty (BAV) in the elderly patient. While arguing that BAV should be used in patients unfit for surgical aortic valve replacement (AVR) due to relative contraindications their results reveal widely unfavourable outcomes particularly with regard to survival and mortality rates. In contrast, surgical AVR yields excellent results in the mid- and long-term follow-up even in a high-risk patient population. In the rare case of real contraindications to surgical AVR transcatheter valve implantation techniques seem to be the more adequate alternative today.
