Hosts Mitsuaki Sawano, MD, and Shun Kohsaka, MD, FACC, welcome Saki Ito, MD, a physician scientist at the Mayo Clinic, to discuss key topics expected at the upcoming ACC.25 in Chicago and a nuanced phenotype of aortic stenosis (AS): high-gradient AS with an aortic valve area (AVA) greater than 1.0 cm². Drawing from a recent retrospective study at Mayo Clinic, Dr. Ito examines the heterogeneous nature of this group—including patients with bicuspid valves and elevated stroke volume due to larger body size—and the potential prognostic benefit of aortic valve replacement (AVR) despite the absence of classic severity markers.