A 70-year-old man with severe calcific aortic stenosis (AVA 0.7 cm², mean gradient 55 mmHg) is symptomatic with exertional dyspnea but has preserved LVEF of 60%. STS-PROM score is 8%. According to current ACC/AHA guidelines, the recommended intervention is:

• A Surgical aortic valve replacement (SAVR)
• B Balloon aortic valvuloplasty as definitive treatment
• C Transcatheter aortic valve replacement (TAVR) ✓
• D Medical management with diuretics and afterload reduction

Explanation

An STS-PROM score of 8% indicates high surgical risk; ACC/AHA guidelines recommend TAVR for high-surgical-risk patients (STS >8%). Multiple trials (PARTNER, SURTAVI, PARTNER 3, Evolut Low Risk) have established TAVR as non-inferior or superior to SAVR across risk categories. Balloon aortic valvuloplasty is only a bridge to definitive therapy. Medical management does not alter the natural history of symptomatic severe AS (annual mortality ~25% without intervention).

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

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Written and medically reviewed by the StethoPrep medical team.