A 72-year-old man has severe symptomatic aortic stenosis (AVA 0.7 cm², mean gradient 48 mmHg) with LVEF of 30%. He is a high surgical risk patient (STS score 9%). According to ACC/AHA 2021 valve guidelines, the preferred intervention is:

• A Balloon aortic valvuloplasty as a bridge to recovery
• B Transcatheter aortic valve implantation/replacement (TAVI/TAVR) ✓
• C Surgical aortic valve replacement (SAVR)
• D Medical management with diuretics and vasodilators until LVEF improves to >40%

Explanation

TAVI (transcatheter aortic valve implantation) is recommended (Class I) for severe symptomatic AS in patients at high or prohibitive surgical risk, based on PARTNER trials demonstrating superiority over medical therapy and non-inferiority/superiority to SAVR in high-risk patients. An STS score >8% typically defines high surgical risk. Low-flow, low-gradient AS with reduced EF may require dobutamine stress echocardiography to confirm severity before proceeding with TAVI. Balloon valvuloplasty is only a temporising bridge.

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

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Written and medically reviewed by the StethoPrep medical team.