A 68-year-old man presents with dyspnea on minimal exertion, angina, and near-syncope. Echocardiogram reveals severe aortic stenosis: valve area 0.7 cm², mean gradient 55 mmHg, peak velocity 4.8 m/s. LVEF is 35%. He is high surgical risk (STS score 8%). Which intervention is recommended?

• A Surgical aortic valve replacement (SAVR)
• B Balloon aortic valvuloplasty as bridge to surgery
• C Transcatheter aortic valve implantation (TAVI/TAVR) ✓
• D Medical management with ACE inhibitors and beta-blockers

Explanation

Transcatheter aortic valve implantation (TAVI/TAVR) is now recommended for symptomatic severe aortic stenosis in patients at high or prohibitive surgical risk (STS score ≥8% or Society Heart Valve guidelines equivalent). This patient has all three classic symptoms of severe AS (angina, syncope, dyspnea = SAD triad) with a mean gradient >40 mmHg and AVA <1.0 cm², meeting criteria for intervention. PARTNER and SURTAVI trials established TAVR superiority over SAVR in high-risk patients. Medical therapy does not improve survival in symptomatic severe AS.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.