In a new Annals ‘Beyond the Guideline’s feature, a cardiologist and a cardiothoracic surgeon debate the risks and benefits of transcatheter aortic valve replacement (TAVR) versus surgical aortic valve replacement (SAVR) for a patient with severe symptomatic aortic stenosis who is at low risk for surgical death. All ‘Beyond the Guidelines’ features are based on the Department of Medicine Grand Rounds at Beth Israel Deaconess Medical Center (BIDMC) in Boston and include print, video, and educational components published in Annals of Internal Medicine.