A 65-year-old man with severe symptomatic aortic stenosis (aortic valve area 0.7 cm², mean gradient 52 mmHg, LVEF 55%) is deemed intermediate surgical risk (STS score 5%). According to current ACC/AHA 2021 VHD guidelines, which intervention is preferred?
- A Surgical aortic valve replacement (SAVR) in all intermediate-risk patients
- B Medical management with ACE inhibitors and diuretics
- C Transcatheter aortic valve replacement (TAVR) is acceptable alternative to SAVR ✓
- D Balloon aortic valvuloplasty as definitive therapy
Correct answer: C. Transcatheter aortic valve replacement (TAVR) is acceptable alternative to SAVR
Explanation
Based on the PARTNER 2A trial and SURTAVI trial, TAVR is a Class IIa (reasonable) alternative to SAVR in intermediate-risk patients with severe symptomatic AS, with similar 2-year mortality and stroke outcomes. In high-risk and inoperable patients, TAVR has a Class I recommendation. In low-risk patients (PARTNER 3, Evolut Low Risk trials), TAVR showed non-inferiority to SAVR at 2 years. Balloon valvuloplasty is only a bridge to definitive therapy. Medical management for severe symptomatic AS is not appropriate—the only treatment is valve replacement.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.