A 72-year-old man with severe symptomatic aortic stenosis (valve area 0.7 cm², mean gradient 55 mmHg, EF 55%) has a Society of Thoracic Surgeons (STS) predicted operative mortality of 4.5% (intermediate surgical risk). What does the evidence from PARTNER 2 and SURTAVI trials support regarding TAVR vs. SAVR for this patient?
- A SAVR is preferred for all patients with STS score > 4% due to better durability
- B Medical management alone is appropriate for STS score 4–6%
- C TAVR is non-inferior to SAVR in intermediate-risk patients and is preferred when anatomy is suitable, offering lower stroke risk and faster recovery ✓
- D TAVR is superior in intermediate risk; SAVR reserved for low-risk patients only
Correct answer: C. TAVR is non-inferior to SAVR in intermediate-risk patients and is preferred when anatomy is suitable, offering lower stroke risk and faster recovery
Explanation
The PARTNER 2 (Edwards SAPIEN 3) and SURTAVI (Medtronic CoreValve) trials established that TAVR is non-inferior to SAVR for intermediate-risk severe AS patients. TAVR offers advantages of shorter hospital stay, faster recovery, and lower peri-procedural stroke rates in experienced centres. The 2021 ACC/AHA valvular guidelines now recommend TAVR as a shared decision-making alternative to SAVR for intermediate-risk patients aged ≥ 65. Durability concerns at longer follow-up are still being evaluated.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.