A 65-year-old man with severe aortic stenosis (AVA 0.7 cm², mean gradient 52 mmHg) and EF of 35% is considered for intervention. He has multiple comorbidities with an STS surgical risk score of 9%. Per the 2021 ACC/AHA guidelines, the preferred intervention is:
- A Transcatheter aortic valve implantation (TAVI/TAVR) ✓
- B Surgical aortic valve replacement (SAVR)
- C Balloon aortic valvuloplasty as bridge
- D Medical management with afterload reduction
Correct answer: A. Transcatheter aortic valve implantation (TAVI/TAVR)
Explanation
Per the 2021 ACC/AHA valvular heart disease guidelines, TAVR is recommended (Class I) for patients with severe symptomatic AS at high or prohibitive surgical risk (STS score >8% or ≥3 high-risk features). An STS score of 9% places this patient in the high-risk category. TAVR is also now a Class IIa recommendation for intermediate-risk patients (STS 4–8%). Medical management with vasodilators is contraindicated in severe AS. Balloon valvuloplasty is only a temporary bridge when definitive intervention must be delayed.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.