A 68-year-old man has severe aortic stenosis (AVA 0.7 cm², mean gradient 55 mmHg, LVEF 35%). He has NYHA class III symptoms and is deemed high surgical risk (STS score 9%). According to current ACC/AHA 2021 VHD guidelines, the preferred intervention is:

• A Surgical aortic valve replacement (SAVR) regardless of surgical risk
• B Medical management with diuretics and vasodilators pending LVEF improvement
• C Balloon aortic valvuloplasty as definitive treatment
• D Transcatheter aortic valve replacement (TAVR) as preferred intervention for high-surgical-risk patients ✓

Explanation

The PARTNER and CoreValve trials established that TAVR is superior to medical management and non-inferior to SAVR in high-risk and intermediate-risk patients. ACC/AHA 2021 guidelines recommend TAVR (Class I) for patients with severe symptomatic AS who are high or prohibitive surgical risk (STS >8% for SAVR) and suitable anatomy. In intermediate risk (STS 4-8%), TAVR and SAVR are considered equivalent. Balloon valvuloplasty provides only temporary relief and is a bridge measure. Medical therapy does not address severe AS and results in poor prognosis. LVEF <50% with severe AS represents a Class I indication for intervention, not watchful waiting.

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

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Written and medically reviewed by the StethoPrep medical team.