Aortic valve replacement via open heart surgery, although still the standard treatment for severe symptomatic aortic valve stenosis, is not an option for many patients with severe symptoms, and these patients are often left with suboptimal strategies such as medical management or balloon valvuloplasty. But over the last 5 years improvements in percutaneous approaches to implantation of prosthetic aortic valves have made it a potential therapeutic option for these patients. Technical and device issues are being refined, and percutaneous aortic valve replacement is showing promise in ongoing clinical trials.