Operating on patients too late carries the risk of development of irreversible heart failure. Operating too early exposes patients to unnecessary risks and adverse events, conceivably causing short (e.g. valve thrombosis) or long term sequelae (e.g. early valve degeneration). According to the current National and European guidelines, medical decision making is, however, limited to the assessment of clinical symptoms, blood pressures and diagnostic imaging of global pump function (ejection fraction and ventricular chamber size)4,5. In addition, the valve opening area is used in settings where the ventricle cannot build up pressures across the valve (e.g. by combined aortic stenos and mitral insufficiency or global LV dysfunction). The planned DSS shall go clearly beyond such gross parameters by looking at the cardiovascular system at a more holistic and multi-scale way. In addition, the DSS shall allow for better personalisation of treatment strategies.