Aortic stenosis (AS) is the most common valvular disease in the western world affecting mainly individuals older than 60 years. It is recognized as an indolent disease characterized by years to decades of slow progression followed by rapid clinical deterioration and high mortality once symptoms develop. Medical therapies for AS remain ineffective with surgical aortic valve replacement (AVR) remaining the only proven effective long-term treatment. The advancement in transcatheter AVR has revolutionized the treatment of inoperable severe AS and holds promise for future widespread use as more long-term experience is established. The authors review the natural history of AS presentation with a special emphasis on management of severe AS and advancement in transcatheter AVR.