A 70-year-old man with severe symptomatic aortic stenosis (AVA 0.7 cm², mean gradient 52 mmHg, LVEF 55%) is deemed 'intermediate surgical risk' (STS score 5.2%). Per current ACC/AHA 2021 valvular guidelines, what is the preferred treatment?
- A Surgical aortic valve replacement (SAVR)
- B Both TAVR and SAVR are equally acceptable — decision should be made by the Heart Team ✓
- C Transcatheter aortic valve replacement (TAVR) is preferred over SAVR
- D Medical management with ACE inhibitor and diuretics
Explanation
Per ACC/AHA 2021 Valvular Heart Disease Guidelines, for symptomatic severe AS in intermediate-risk patients (STS 4-8%), both TAVR and SAVR are Class I recommendations — they are equivalent in terms of outcomes at 2 years (PARTNER 2, SURTAVI trials). The choice between TAVR and SAVR should be made by a multidisciplinary Heart Team considering anatomical, operator, and patient factors (valve anatomy suitability for TAVR, femoral access, need for concomitant coronary or mitral valve disease, patient preference, long-term prosthesis durability concerns in younger patients). TAVR is favored in high/very-high surgical risk.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.