While the PARTNER Trial data is being evaluated, ongoing studies are being continued in Europe in which patients have not been randomized but are being followed. The method of insertion has varied somewhat from site to site, with some sites, for example the group in Leipzig, prefer a transapical approach, whereas those in other centers prefer a transfemoral approach. In the centers in which the transapical approach has been used almost exclusively in patients, the reported results have so far been equivalent to those for the transfemoral approach. We note that the perceived advantages for the transapical approach are a quicker time for insertion, less contrast, and less risk of stroke. On the other hand, patients with severe lung disease and oxygen dependency do not tolerate this procedure well because it requires a minithoracotomy. The obvious benefits for the transfemoral approach are quicker recovery and earlier mobilization of patients, but this may be burdened with a higher risk of stroke and, clearly, there is a risk of vascular injury, which was 17% in the initial series in the Revival trial. This, however, has been reduced considerably and with the 18-French device becoming available in 2010, it is likely that both the rate of injury will be reduced and also the number of patients who need a transapical approach. The other option is to use the subclavian artery or mini aortic approach for insertion of the device.