Transcatheter aortic valve replacement (TAVR) — per ACC/AHA 2021 guidelines, TAVR is now recommended over surgical AVR (SAVR) for which patient group?

• A Only high surgical risk patients (STS score >8%) or those considered inoperable
• B Patients at high or prohibitive surgical risk; either TAVR or SAVR for intermediate risk; SAVR preferred for low-risk patients <65 years ✓
• C All patients with severe aortic stenosis regardless of age and surgical risk
• D Low surgical risk patients >75 years only

Explanation

Per ACC/AHA 2021 valvular heart disease guidelines: TAVR is recommended for severe AS patients at prohibitive or high surgical risk (STS score >4–8%). For intermediate surgical risk, either TAVR or SAVR is reasonable based on patient/heart team discussion. For low surgical risk (STS <4%), SAVR is generally preferred in patients <65 years with long life expectancy (given TAVR valve durability concerns and structural valve degeneration), while TAVR is an alternative in low-risk patients aged >65–75. PARTNER 3 and EVOLUT Low Risk trials demonstrated TAVR non-inferiority to SAVR in low-risk patients at 2 years.

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

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Written and medically reviewed by the StethoPrep medical team.