A 70-year-old man with severe aortic stenosis (AVA 0.7 cm², mean gradient 55 mmHg, LVEF 35%) is assessed for intervention. He has a REDO cardiac surgery history making reoperation high-risk. STS score is 8.2%. Which procedure is recommended per AHA/ACC 2021 guidelines?

• A Surgical aortic valve replacement (SAVR) despite high risk
• B Transcatheter aortic valve replacement (TAVR) ✓
• C Balloon aortic valvuloplasty as bridge to definitive therapy
• D Medical therapy with afterload reduction and diuretics

Explanation

AHA/ACC 2021 valvular heart disease guidelines (Class I, LOE A) recommend TAVR for severe symptomatic AS in patients with prohibitive or high surgical risk (STS-PROM ≥8% or Heart Team assessment). PARTNER 2A and SURTAVI trials demonstrated TAVR non-inferiority to SAVR in intermediate-risk patients, and PARTNER 3 showed TAVR superiority in low-risk patients at 2 years. This patient's STS >8% plus redo surgery anatomy makes TAVR the preferred option. Balloon valvuloplasty is palliative only. Medical therapy does not alter natural history of severe AS.

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

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Written and medically reviewed by the StethoPrep medical team.