A 72-year-old man has aortic stenosis with valve area 0.7 cm², mean gradient 62 mmHg, and LVEF 35%. He has NYHA Class III symptoms. STS score is 8% (high surgical risk). Which treatment modality is most appropriate?

• A Surgical aortic valve replacement (SAVR)
• B Transcatheter aortic valve implantation (TAVI) ✓
• C Balloon aortic valvuloplasty as definitive treatment
• D Medical management with diuretics and ACE inhibitor

Explanation

TAVI is the treatment of choice for severe symptomatic aortic stenosis in high-surgical-risk patients (STS score ≥8% or STS score ≥4% with other factors). Multiple trials (PARTNER, SURTAVI) have established non-inferiority or superiority of TAVI over SAVR in high and intermediate risk groups. Balloon valvuloplasty provides only temporary relief and is used as a bridge. Medical therapy is palliative; ACE inhibitors require caution in severe fixed obstruction. This patient's low LVEF (likely flow-gradient discordance) still warrants intervention if truly severe AS.

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

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Written and medically reviewed by the StethoPrep medical team.