A 65-year-old man with severe aortic stenosis (AVA 0.7 cm², mean gradient 52 mmHg, peak velocity 4.8 m/s) is referred for intervention. He is high surgical risk (STS score 8%). Which of the following most accurately reflects the current ACC/AHA 2021 VHD guideline recommendations?
- A TAVR and SAVR have equivalent outcomes in all age groups regardless of surgical risk
- B Balloon aortic valvotomy is the preferred intervention in high-risk elderly patients
- C TAVR is preferred over SAVR for high-surgical-risk patients with severe symptomatic AS ✓
- D Medical management with ACE inhibitors until symptoms progress further
Explanation
Per ACC/AHA 2021 valvular heart disease guidelines, TAVR is the recommended (Class I) intervention for severe symptomatic aortic stenosis in patients with high or prohibitive surgical risk. For intermediate-risk patients, TAVR is also reasonable (Class IIa). The landmark PARTNER trials (PARTNER 1B, PARTNER 2, PARTNER 3) established TAVR superiority or non-inferiority across risk categories. For younger patients (<65 years) or those with bicuspid aortic valve, SAVR is preferred due to concerns about structural valve deterioration and the need for reoperation with a predictable lifespan of prosthetic valve. Balloon aortic valvotomy is palliative only.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.