any heavy lifting for 4–6 months after surgery to avoid damaging their breastbone. Often patients will be referred to participate in cardiopulmonary rehabilitation, which optimizes recovery and physical function in patients with recent cardiac surgeries. This can be done in an outpatient setting. Outcomes Surgery usually relieves the aortic disease symptoms that led the patient to the operating room. The survival curve of patients who undergo aortic valve replacements is slightly inferior to the curve of their corresponding healthy same-aged same sex population. Pre-operative severe left ventricular hypertrophy is a contributing factor to morbidity. The risk of dying as a result of aortic valve replacement is estimated at 1–3%. Combining aortic valve replacement with coronary artery bypass grafting increases the risk of mortality. Older patients, as well as those who are frail and/or have other health problems (comorbidities), have a higher risk of experiencing complications. Possible problems include cardiac infarction or failure, arrhythmia or heart block typically requiring the permanent insertion of a cardiac pacemaker, mediastinal bleeding, stroke and infection. Late complications include endocarditis, thromboembolic events (blood clots), prosthetic valve dysfunction and paravalvular leak (blood flowing between the edge of the prosthetic valve and the cardiac tissue). Patient–prosthesis mismatch When dealing with a small aortic annulus, the surgeon might have to insert a prosthetic aortic valve of small size, with an orifice too small in relation to the size of the patient (patient–prosthesis mismatch). This increases the pressure of the blood flowing through the valve, and can lead to worse outcomes. Various techniques, imcluding stentless valves, have been utilized to avoid this problem. Less invasive procedures Minimally invasive cardiac surgery Since the late 1990s, some cardiac surgeons have been performing aortic valve replacement using an approach referred to as minimally invasive cardiac surgery (MICS). Using this approach, the surgeon replaces the valve through a smaller chest incision (6–10 cm) than that for a median sternotomy. MICS typically requires shorter recovery times, and produces less visible scarring. Transcatheter aortic valve replacement Another alternative for many high-risk or elderly patients is transcatheter aortic valve replacement (TAVR, also known as TAVI, transcatheter aortic valve implantation). Rather than removing the existing valve, the new valve is pushed through it in a collapsed state. It is delivered to the site of the existing valve through a tube called a catheter, which may be inserted through the femoral artery in the thigh (transfemoral approach), or using