A 68-year-old man with severe calcific aortic stenosis (valve area 0.7 cm², mean gradient 52 mmHg, LVEF 60%) is symptomatic with exertional angina. His STS score is 8% (high surgical risk). According to AHA/ACC 2021 valve guidelines, the preferred treatment is:

• A Surgical aortic valve replacement (SAVR) as gold standard
• B Aortic balloon valvuloplasty as definitive therapy
• C Medical management with vasodilators and diuretics
• D Transcatheter aortic valve replacement (TAVR) ✓

Explanation

TAVR (Transcatheter Aortic Valve Replacement) is indicated for symptomatic severe AS in high-surgical-risk patients (STS ≥8%) per AHA/ACC 2021 guidelines. The PARTNER 1A, PARTNER 2A, PARTNER 3, and EVOLUT LOW RISK trials progressively expanded TAVR to intermediate and low-risk patients. For high-risk patients, TAVR is preferred over SAVR. The PARTNER 1A trial demonstrated superior survival with TAVR vs medical therapy in inoperable patients, and non-inferior to SAVR in high-risk surgical patients. Balloon valvuloplasty has very high restenosis rates and is only a bridge to definitive therapy. Vasodilators are relatively contraindicated in severe AS (can cause hypotension).

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

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Written and medically reviewed by the StethoPrep medical team.