Aortic stenosis (AS) is the most common form of valvular heart disease in the elderly. As this patient population continues to increase, anesthesiologists more often will encounter these patients in the perioperative setting for noncardiac surgical procedures. Cardiac risk during noncardiac surgery in the patient with AS appears to have decreased significantly compared with previous reports that shaped current practice guidelines for perioperative management. In addition, these guidelines preceded the publication of current data supporting the continually expanding role for transcatheter aortic valve replacement in the treatment of AS. In this review, the authors highlight the most recent evidence suggesting that an update of these guidelines is warranted. In addition, the accumulating evidence supporting the role for transcatheter aortic valve replacement to treat AS since the publication of guidelines is reviewed.