A 70-year-old woman with severe symptomatic aortic stenosis (valve area 0.7 cm², mean gradient 52 mmHg) has LVEF 35% and STS surgical risk score of 8.5%. She has a hostile chest and severe COPD. The most appropriate intervention is:

• A Surgical aortic valve replacement (SAVR)
• B Transcatheter aortic valve implantation (TAVI) ✓
• C Balloon aortic valvuloplasty as definitive therapy
• D Medical management with ACE inhibitor and diuretics

Explanation

TAVI is the treatment of choice for severe symptomatic AS in patients with high or prohibitive surgical risk (STS score ≥8% or prohibitive risk from comorbidities). The PARTNER trials established TAVI superiority over medical therapy and non-inferiority (and later superiority in intermediate risk) versus SAVR. This patient's STS score of 8.5%, hostile chest, reduced LVEF, and severe COPD make her a high-risk SAVR candidate. Balloon valvuloplasty is a temporizing bridge, 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.