A 72-year-old woman has severe aortic stenosis (aortic valve area 0.7 cm², mean gradient 52 mmHg, peak velocity 4.8 m/s) with EF 38% and is NYHA class III. Society of Thoracic Surgeons predicted risk of mortality (STS-PROM) is 7.2%. She has no significant vascular or technical contraindications to TAVR. Which statement best reflects current AHA/ACC 2021 guidelines?
- A SAVR is mandatory in patients with preserved surgical risk regardless of EF
- B Medical therapy with diuretics and ACE inhibitors is preferred in low-EF AS to restore EF before intervention
- C TAVR is preferred as it has been shown in PARTNER 2, SURTAVI, and PARTNER 3 to be non-inferior or superior to SAVR even in intermediate surgical risk ✓
- D BNP-guided conservative management is appropriate given her age and comorbidities
Correct answer: C. TAVR is preferred as it has been shown in PARTNER 2, SURTAVI, and PARTNER 3 to be non-inferior or superior to SAVR even in intermediate surgical risk
Explanation
AHA/ACC 2021 valve guidelines state that for severe symptomatic AS in patients ≥ 75 years or intermediate-high surgical risk (STS ≥ 4–8%), TAVR is recommended (Class I indication) and has been shown non-inferior to SAVR in intermediate-risk patients in PARTNER 2 and SURTAVI, and superior in low-risk elderly patients in PARTNER 3. With an STS of 7.2% (high risk), TAVR is strongly indicated. Medical therapy does not reverse mechanical obstruction; AS with low EF requires valve replacement, not diuretics alone.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.