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Each outcome was described in simple language. Patients were also asked to distribute $100 among the 10 outcomes, proportionally more money being allocated to the more undesirable outcomes. The dollar allocations were used to determine the relative value of each outcome. Rankings and relative value scores correlated closely (r 2 = 0.69). Patients rated from most undesirable to least undesirable (in order): vomiting, gagging on the tracheal tube, incisional pain, nausea, recall without pain, residual weakness, shivering, sore throat, and somnolence (F-test < 0.01).Implications Although there is variability in how patients rated postoperative outcomes, avoiding nausea/vomiting, incisional pain, and gagging on the endotracheal tube was a high priority for most patients. Whether clinicians can improve the quality of anesthesia by designing anesthesia regimens that most closely meet each individual patient’s preferences for clinical outcomes deserves further study. PREAMBLE This document has been developed as an Expert Consensus Document (ECD) by the American College of Cardiology Foundation (ACCF), American Association for Thoracic Surgery (AATS), Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons in collaboration with the American Heart Association (AHA), American Society of Echocardiography, European Association for Cardio-Thoracic Surgery, Heart Failure Society of America, Society of Cardiovascular Computed Tomography, Society of Cardiac Magnetic Resonance, Society of Cardiovascular Anesthesiologists, andMended Hearts. ECDs are intended to inform practitioners, payers, and other interested parties of the opinion of ACCF and document cosponsors concerning evolving areas of clinical practice and/or technologies that may be widely available or may be new to the practice community. Topics chosen for coverage by ECDs are so designed because the evidence base, the experience with technology, and/or clinical practice are not considered suffi- ciently well developed to be evaluated by the formal ACCF/ AHA Practice Guidelines process. Often the topic is the subject of considerable ongoing investigation. Thus, the reader should view the ECD as the best attempt of the ACCF and document cosponsors to inform and guide clinical practice in areas where rigorous evidence may not yet be available or evidence to date is not widely applied to clinical practice. When feasible, ECDs include indications or contraindications. Some topics covered by ECDs will be addressed subsequently by the ACCF/AHA Practice Guidelines Committee. To avoid actual, potential, or perceived conflicts of interest that may arise as a result of industry relationships or personal interests among the writing committee, all members of the writing committee, as well as peer reviewers of the document, are asked to disclose all current health care– related relationships, including those existing 12 months before initiation of the writing effort. The ACCF Task Force on Clinical Expert Consensus Documents (TF CECD) reviews these disclosures to determine what companies make products (on market or in development) that pertain to the document under development. Based on this information, a writing committee is formed to include a majority of members with no relevant relationships with industry or other entity (RWI), led by a chair with no relevant RWI. Authors with relevant RWI are not permitted to draft or vote on text or recommendations pertaining to their RWI. RWI is reviewed on all conference calls and updated as changes occur. Additionally, to ensure complete transparency, authors’ comprehensive health care–related disclosure information—including RWI not pertinent to this document—is available online. Disclosure information for the ACCF TF CECD is also available online at www.cardiosource.org/ACC/ About-ACC/Leadership/Guidelines-and-Documents-TaskForces.aspx, as well as the ACCF disclosure policy for document development at www.cardiosource.org/ScienceAnd-Quality/Practice-Guidelines-and-Quality-Standards/ Relationships-With-Industry-Policy.aspx. The work of the writing committee was supported exclusively by the ACCF without commercial support. Writing committee members volunteered their time to this effort. Conference calls of the writing committee were confidential and attended only by committee members. Robert A. Harrington, MD, FACC Chair, ACCF Task Force on Clinical Expert Consensus Documents INTRODUCTION Document Development Process: Writing Committee Organization The Writing Committee consisted of a broad range of members representing 12 societies and the following areas of expertise: cardiothoracic surgery, interventional cardiology, general cardiology, geriatric cardiology, echocardiography, cardiac anesthesiology, cardiac computed tomography (CT), cardiac magnetic resonance (CMR), cardiac nursing, heart failure, neurology, valvular heart disease, structural heart disease, and the consumer perspective. Geographic distribution of members crossed most U.S. time zones and included international representation. Members with expertise using this new and emerging technology and those with expertise in their content area, but not in the procedure discussed herein, served on the committee to provide appropriate balance of perspectives. This writing committee met the College’s disclosure requirements for relationships with industry as described in the Preamble. Important to note, if an author works in an institution that serves as a TAVR trial site but has no direct relationship with the trial sponsor or other relevant company (that produces [competing] products or services discussed in this document) or institutional relationship as defined by the ACCF Disclosure Policy for Document Development, the trial site information was not deemed relevant to this writing effort and is not included in the table of relevant author disclosures. For example, if an author works in an institution where TAVR is performed, but he/she: (1) does not personally perform the procedure; or (2) performs the procedure but has no direct relationship to the trial (eg, principal investigator, investigator, steering committee member, consultant) and does not oversee funds related to the trial, then the relationship is not included in the table of relevant disclosures. In these situations, these relationships do not even need to be disclosed.