A 65-year-old man has severe aortic stenosis (AVA 0.7 cm², mean gradient 52 mmHg, LVEF 35%). He has severe COPD (FEV1 35% predicted) and prior coronary artery bypass graft surgery. The STS operative mortality score is 12%. The MOST appropriate intervention is:

• A Surgical aortic valve replacement (SAVR) given the low AVA
• B Medical management with diuretics and digoxin
• C Transcatheter aortic valve implantation (TAVI) given the high surgical risk ✓
• D Balloon aortic valvuloplasty as definitive treatment

Explanation

TAVI (transcatheter aortic valve implantation) is now recommended for severe symptomatic aortic stenosis in patients at intermediate or high surgical risk (STS score ≥4–8%) or those deemed inoperable. With STS score 12% (high risk), severe COPD limiting lung reserve, and redo sternotomy required after prior CABG, this patient is a clear TAVI candidate. The PARTNER, CoreValve, and PARTNER 3 trials established TAVI equivalence or superiority to SAVR in high-risk patients. Balloon valvuloplasty provides only temporary palliation without durability.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.