Patient description: The patient is a 25-year-old man with type 1 diabetes confirmed with molecular analysis 7 years ago. He presents to the clinic with shortness of breath and fatigue during activities. He claims mild dyspnea after climbing 3 floors, no dyspnea at rest and no angina (New York Heart Association class 2). He is diagnosed with cardiomyopathy that will be treated with ACE inhibitors and Beta blockers. His takes 70/30 Insulin and vitamin D supplements. His past medical history is not significant for any other medical issues. His family history is positive for DM type 1 in his uncle and his grandfather. His lab study is as bellow: FBS: 100 mg/dl HbA1c: 6.5% Cholesterol: 190 mg/dl TG: 140 mg/dl LDL: 125 mg/dl HDL: 40 mg/dl

Clinical trial eligibility criteria: eligible ages (years): 0.0-999.0,  Aortic Stenosis Severe, degenerative AS, defined as: 1. mean aortic valve gradient ≥40 mm Hg OR Vmax ≥4 m/sec AND 2. calculated aortic valve area ≤1.0 cm2 OR aortic valve area index ≤0.6 cm2/m2 2. Symptomatic AS, defined as a history of at least one of the following: 1. dyspnea that qualifies at New York Heart Association (NYHA) class II or greater 2. angina pectoris 3. cardiac syncope 3. The Heart Team, including at least one cardiothoracic surgeon and one interventional cardiologist, deem the patient to be reasonable for transfemoral TAVR with a commercially available bioprosthetic valve 4. The Heart Team agrees that the patient is low-risk, quantified by an estimated risk of ≤3% by the calculated STS score for operative mortality at 30 days; AND agrees that SAVR would be an appropriate therapy if offered. 5. The Heart Team agrees that transfemoral TAVR is anatomically feasible, based upon multislice CT measurements 6. Procedure status is elective 7. Expected survival is at least 24 months For the bicuspid cohort only: 8. Aortic Stenosis of a bicuspid aortic valve  Concomitant disease of another heart valve or the aorta that requires either transcatheter or surgical intervention 2. Any condition that is considered a contraindication for placement of a bioprosthetic aortic valve (e.g. patient requires a mechanical aortic valve) 3. Aortic stenosis secondary to a bicuspid aortic valve (except for the bicuspid valve cohort) 4. Prior bioprosthetic surgical aortic valve replacement 5. Mechanical heart valve in another position 6. End-stage renal disease requiring hemodialysis or peritoneal dialysis, or a creatinine clearance <20 cc/min 7. Left ventricular ejection fraction <20% 8. Recent (<6 months) history of stroke or transient ischemic attack 9. Symptomatic carotid or vertebral artery disease, or recent (<6 weeks) surgical or endovascular treatment of carotid stenosis 10. Any contraindication to oral antiplatelet or anticoagulation therapy following the procedure, including recent or ongoing bleeding, or score >3 11. Severe coronary artery disease that is unrevascularized 12. Recent (<30 days) acute myocardial infarction 13. Patient cannot undergo transfemoral TAVR for anatomic reasons (as determined by supplemental imaging studies); this would inadequate size of iliofemoral access vessels or an aortic annulus size that is not accommodated by the commercially available valves 14. Any comorbidity not captured by the STS score that would make SAVR high risk, as determined by a cardiothoracic surgeon who is a member of the heart team; this includes: 1. porcelain or severely atherosclerotic aorta 2. frailty 3. hostile chest 4. IMA or other conduit either crosses midline of sternum or is adherent to sternum 5. severe pulmonary hypertension (PA systolic pressure > 2/3 of systemic pressure) 6. severe right ventricular dysfunction 15. Ongoing sepsis or infective endocarditis 16. Recent (<30 days) or ongoing bleeding that would preclude treatment with anticoagulant or antiplatelet therapy, including recent gastrointestinal bleeding 17. Uncontrolled atrial fibrillation (resting heart rate >120 beats per minute) 18. Severe chronic obstructive pulmonary disease, as demonstrated by forced expiratory volume (FEV1) <750 cc 19. Liver failure with Childs class C or D 20. Pre-procedure shock, inotropes, mechanical assist device, or cardiac arrest 21. Pregnancy or intent to become pregnant prior to completion of all protocol follow-up procedures 22. Known allergy to warfarin or aspirin