OBJECTIVES: Surgical aortic valve replacement (sAVR) represents the gold standard for treatment in patients who require valve replacement therapy. However, the risks and costs are not uniform across all patients. We have examined the national hospital costs database of France to detail the variability of outcomes and costs in an attempt to allow improved decision making when deciding on appropriate interventions. METHODS: The Programme de Médicalisation des Systèmes d'Information (PMSI) hospital database for 2010 was examined and all discharge records retrieved for patients undergoing aortic valve replacement. In addition to the discharge costs information on hospital length of stay, mortality and Charlson risk score were also obtained. RESULTS: The mean cost for all 12,512 recorded sAVR procedures (defined as Groupe homogène de maladies (GHM) codes 05C02 and 05C03) in 2010 was €19,029 (median €17,349). Overall hospital mortality was 5.94% but increased to 26.06% depending on severity level and GHM code. Corresponding total costs increased if patients died prior to discharge by €11,007 and €9,200 for 05C02 and 05C03 respectively but also differed by severity, generally increasing together with mortality up to a maximum mean of €42,063. Hospital length of stay (LoS) also varied by severity levels with means of between 10.74 and 27.91 days dependent on severity. CONCLUSIONS: The costs and outcomes of sAVR vary enormously and a single point estimate cannot be used to adequately to reflect them. Therapeutic choices must be tailored to the individual patient and has the potential to generate substantial cost reductions for the payer by avoiding mortality and reducing LoS. We present this in the context of new  treatment options for aortic valve replacement.