Valvular heart disease is emerging as a progressively more common cause of congestive heart failure. Proper timing is crucial in managing these patients. However, it is not uncommon to find patients with valvular disease and advanced heart failure that may have missed the surgical window. The question often arises “Does left or right ventricle dysfunction become so far advanced that surgery is impossible?" The advent of percutaneous devices may advance the timing of mechanical intervention further with potential improvement in outcomes and delay the need of mechanical support or transplant. This session will provide guidance on how to approach these patients based on current knowledge and the future in an area that is evolving.