Tarantini G, et al. - From the OBSERVANT [OBservational Study of Effectiveness of surgical aortic valve replacement (SAVR)-TAVR procedures for severe Aortic steNosis Treatment] real-world study, patients younger than 80 years undergoing transfemoral transcatheter aortic valve implantation (TAVI) or SAVR were examined for their baseline features and clinical outcomes, focusing on variables guiding Heart Team decision toward TAVI. In OBSERVANT, patients with symptomatic severe aortic stenosis (AS) who underwent SAVR or TAVI in 93 Italian participating hospitals were enrolled. Observations revealed significantly higher logistic EuroSCORE and prevalence of comorbidities among patients < 80 years of age with severe symptomatic AS undergoing TAVI (n = 483) vs those undergoing SAVR (n = 4,318). Anatomical factors, mainly previous cardiac surgery and the presence of porcelain aorta, and clinical factors, mainly moderate-severe frailty score, oxygen dependency and need for dialytic treatment, led to the decision of performing TAVI over SAVR. Patients under 65 years of age had the highest preoperative risk profile and carried the worse outcome despite a low Logistic EuroSCORE.