A 72-year-old man has severe aortic stenosis (AVA 0.7 cm², peak velocity 4.8 m/s, mean gradient 52 mmHg) and is symptomatic (NYHA class II dyspnea). Echocardiogram shows LVEF 55%. STS predicted surgical mortality risk is 7.2%. According to current ACC/AHA 2021 valvular heart disease guidelines, the preferred intervention is:

• A Transcatheter aortic valve replacement (TAVR) ✓
• B Surgical aortic valve replacement (SAVR)
• C Balloon valvuloplasty as bridge to surgery
• D Medical therapy with digoxin and furosemide

Explanation

For severe symptomatic AS in patients at intermediate (STS 4–8%) or high surgical risk (STS >8%), TAVR is the preferred intervention per ACC/AHA 2021 guidelines. The PARTNER 3 and Evolut Low Risk trials extended TAVR benefit to low surgical risk patients. With STS 7.2% (intermediate-high risk) and anatomy suitable for TAVR, it is the Class I recommended approach. SAVR remains the standard for younger low-risk patients, but TAVR outcomes are equivalent or superior for intermediate/high-risk elderly patients. Balloon valvuloplasty is a temporizing measure for hemodynamically unstable patients, not definitive therapy.

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

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Written and medically reviewed by the StethoPrep medical team.