With an ageing population and improved diagnostic modalities, the number of patients with valvular heart disease is dramatically increasing. We are faced with more complex decisions in patients with advanced age and increasing comorbidities. Advances in percutaneous valve interventions -like percutaneous aortic valve replacement and mitral valve repair -have revolutionised the way we manage such diseases. This overview highlights recent advances in the decision makingprocess and the management of patients with valvular heart disease.